Provider Demographics
NPI:1093959504
Name:HARDWICK, GAYLE LYNN (FNP)
Entity Type:Individual
Prefix:
First Name:GAYLE
Middle Name:LYNN
Last Name:HARDWICK
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:GAYLE
Other - Middle Name:LYNN
Other - Last Name:GRIMES
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:FNP
Mailing Address - Street 1:855 WAYNE RD STE B
Mailing Address - Street 2:
Mailing Address - City:SAVANNAH
Mailing Address - State:TN
Mailing Address - Zip Code:38372-1530
Mailing Address - Country:US
Mailing Address - Phone:731-925-4973
Mailing Address - Fax:
Practice Address - Street 1:9615 PORTOFINO DRIVE
Practice Address - Street 2:
Practice Address - City:BRENTWOOD
Practice Address - State:TN
Practice Address - Zip Code:37027
Practice Address - Country:US
Practice Address - Phone:731-607-3246
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-04-28
Last Update Date:2012-02-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN14125363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN103I501996Medicaid
TN4259849OtherBCBS
TN103I501996Medicare PIN