Provider Demographics
NPI:1275913279
Name:GARDNER, DANIEL PHILLIP (FNP)
Entity Type:Individual
Prefix:MR
First Name:DANIEL
Middle Name:PHILLIP
Last Name:GARDNER
Suffix:
Gender:M
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 7987
Mailing Address - Street 2:
Mailing Address - City:MOBILE
Mailing Address - State:AL
Mailing Address - Zip Code:36670-0987
Mailing Address - Country:US
Mailing Address - Phone:251-633-0573
Mailing Address - Fax:251-633-7367
Practice Address - Street 1:8725 COUNTY ROAD 64
Practice Address - Street 2:
Practice Address - City:DAPHNE
Practice Address - State:AL
Practice Address - Zip Code:36526
Practice Address - Country:US
Practice Address - Phone:251-625-1370
Practice Address - Fax:251-625-1380
Is Sole Proprietor?:No
Enumeration Date:2015-06-04
Last Update Date:2024-02-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL1-122937363L00000X, 363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL10138I3499OtherMEDICARE
AL179179Medicaid
AL214334Medicaid
ALZ33078OtherVIVA HEALTH
AL213045Medicaid
AL4992223OtherAETNA
AL512-05548OtherBCBS
AL5581031OtherUHC
MS03323279OtherMS MEDICAID
AL221246Medicaid
AL223477Medicaid
AL222164Medicaid
AL511-67959OtherBCBS
AL511-70269OtherBCBS
AL511-70270OtherBCBS
AL511-95547OtherBCBS
AL512-05546OtherBCBS
ALP01572739OtherRR MEDICARE