Provider Demographics
NPI:1043247760
Name:GARDNER, DANIEL P (MS, CCC-A)
Entity Type:Individual
Prefix:MR
First Name:DANIEL
Middle Name:P
Last Name:GARDNER
Suffix:
Gender:M
Credentials:MS, CCC-A
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:700 SE 5TH TER
Mailing Address - Street 2:STE 11
Mailing Address - City:CRYSTAL RIVER
Mailing Address - State:FL
Mailing Address - Zip Code:34429-4878
Mailing Address - Country:US
Mailing Address - Phone:352-795-5377
Mailing Address - Fax:352-795-8663
Practice Address - Street 1:970 LAKE CARILLON DR
Practice Address - Street 2:STE 300
Practice Address - City:ST PETERSBURG
Practice Address - State:FL
Practice Address - Zip Code:33716-1129
Practice Address - Country:US
Practice Address - Phone:727-202-8924
Practice Address - Fax:352-795-8663
Is Sole Proprietor?:No
Enumeration Date:2006-06-27
Last Update Date:2014-05-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAY477231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLAY477OtherSTATE LICENSE