Individual provider Active NPI

Winston Hardison Jr., RN

  • Psychiatric/Mental Health Nurse Practitioner
  • Palm Bay, FL
National Provider Identifier
1104790831
Registry record updated Mar 26, 2026
On this page

Key facts

NPPES NPI Registry
Primary specialty
Psychiatric/Mental Health Nurse PractitionerTaxonomy code 363LP0808X
License
APRN11045332 Issued in FL
Practice address
828 Walden Blvd SE
Palm Bay, FL 32909-6683
Phone
(321) 302-3599
NPI assigned
Oct 4, 2025
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Mar 26, 2026

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Psychiatric/Mental Health Nurse PractitionerGroup: 193400000X SINGLE SPECIALTY GROUP 363LP0808X APRN11045332 FL Primary
Psychiatric/Mental Health Registered Nurse 163WP0808X 9368976 FL

Addresses

Primary practice location

828 Walden Blvd SE
Palm Bay, FL 32909-6683

Mailing address

828 Walden Blvd SE
Palm Bay, FL 32909-6683
Phone (321) 302-3599

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Not enrolled
Credentials
Registered Nurse

State licenses

LicenseStateTypeSpecialty
9368976FLMDPsychiatric/Mental Health Registered Nurse
APRN11045332FLMDPsychiatric/Mental Health Nurse Practitioner

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1759536000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1774483200000",
    "number": "1104790831",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "828 WALDEN BLVD SE",
            "city": "PALM BAY",
            "state": "FL",
            "postal_code": "329096683",
            "telephone_number": "321-302-3599"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "828 WALDEN BLVD SE",
            "city": "PALM BAY",
            "state": "FL",
            "postal_code": "329096683",
            "telephone_number": "321-302-3599"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "HARDISON",
        "first_name": "WINSTON",
        "name_prefix": "Mr.",
        "name_suffix": "Jr.",
        "credential": "RN",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2025-10-04",
        "last_updated": "2026-03-26",
        "certification_date": "2026-03-26",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LP0808X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Nurse Practitioner, Psychiatric/Mental Health",
            "state": "FL",
            "license": "APRN11045332",
            "primary": true
        },
        {
            "code": "163WP0808X",
            "taxonomy_group": "",
            "desc": "Registered Nurse, Psychiatric/Mental Health",
            "state": "FL",
            "license": "9368976",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Palm Bay, FL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 26, 2026; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.