Provider Demographics
NPI:1124231113
Name:GARNER, PATRICIA MILLER (RD, LD, CDE)
Entity Type:Individual
Prefix:MS
First Name:PATRICIA
Middle Name:MILLER
Last Name:GARNER
Suffix:
Gender:F
Credentials:RD, LD, CDE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3312 47TH ST W
Mailing Address - Street 2:
Mailing Address - City:BRADENTON
Mailing Address - State:FL
Mailing Address - Zip Code:34209-6300
Mailing Address - Country:US
Mailing Address - Phone:941-792-7870
Mailing Address - Fax:
Practice Address - Street 1:BLAKE MEDICAL CENTER
Practice Address - Street 2:2020 59TH ST
Practice Address - City:BRADENTON
Practice Address - State:FL
Practice Address - Zip Code:34209
Practice Address - Country:US
Practice Address - Phone:941-798-6611
Practice Address - Fax:941-798-6023
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-07
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL1288133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLU0208ZMedicare UPIN