Provider Demographics
NPI:1487292421
Name:HARDEN, GRACE ANN (PA)
Entity type:Individual
Prefix:
First Name:GRACE
Middle Name:ANN
Last Name:HARDEN
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:GRACE
Other - Middle Name:ANN
Other - Last Name:NICOLIA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA
Mailing Address - Street 1:523 E 72ND ST FL 3
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10021-4099
Mailing Address - Country:US
Mailing Address - Phone:126-061-9462
Mailing Address - Fax:
Practice Address - Street 1:523 E 72ND ST FL 3
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10021-4099
Practice Address - Country:US
Practice Address - Phone:212-606-1946
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-12-19
Last Update Date:2024-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant