Lonnie Ray Harding, PA-C
Individual provider Active NPI Surgical Physician Assistant · Wimauma, FL
NPI 1154329290 · NPPES record last updated Sep 11, 2025
Key facts
- NPI
- 1154329290
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Surgical Physician Assistant 363AS0400X
- License
- PA2166 (FL)
- Practice address
- 5129 State Road 674
Suite a
Wimauma, FL 33598-3530 - Phone
- (813) 633-8489
- Fax
- (813) 633-2669
- NPI assigned
- Jul 12, 2005
- Sex
- Male
- Sole proprietor
- No
Organizations & group practices 3
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in TX
- Eligible to order & refer
- Part B services: Yes · DME: Yes · Home health: Yes · Power mobility devices: Yes · Hospice: No
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20080103000503 | TX | Practitioner - Physician Assistant | 9133179781 | Reassigns benefits to 1 organization |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
- Credentials
- Physician Assistant
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| PA2166 | FL | MD | Medical Physician Assistant |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Winslow Indian Health Care Center, Inc | Current |
Accepting new patients | |
| Emergency Medicine of Florida, Inc. | Past | Accepting new patients |
Locations
500 Indiana Ave
Winslow, AZ 86047
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Physician Assistant | 363A00000X | PA2166 | FL | |
| Medical Physician Assistant | 363AM0700X | PA2166 | FL | |
| Surgical Physician Assistant | 363AS0400X | PA2166 | FL | Yes |
Addresses
Primary practice location
5129 State Road 674
Suite a
Wimauma, FL 33598-3530
Mailing address
5129 State Road 674
Suite a
Wimauma, FL 33598-3530
Phone (813) 633-8489
Other providers in Wimauma, FL
- Tashe Clarice Green
- Gwendy Gregory
- Carmen Luisa Grillo Alejo
- Joanna J Guzman
- Evonda Carvette Hancock
- Mercedes Harrison
- Lyudmila Petrovna Haviland
- Charita T Hearn
- Heaven in Home Healthcare LLC
- Higher Aspirations Behavior Services, LLC
All providers in Wimauma, FL · Surgical Physician Assistant in Florida
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Sep 11, 2025. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Order and Referring (CMS).
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.