Provider Demographics
NPI:1407954290
Name:GARDUNO, PATRICIA R (APN)
Entity Type:Individual
Prefix:
First Name:PATRICIA
Middle Name:R
Last Name:GARDUNO
Suffix:
Gender:F
Credentials:APN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1301 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:ASBURY PARK
Mailing Address - State:NJ
Mailing Address - Zip Code:07712-5359
Mailing Address - Country:US
Mailing Address - Phone:732-774-6333
Mailing Address - Fax:732-774-0313
Practice Address - Street 1:1301 MAIN ST
Practice Address - Street 2:
Practice Address - City:ASBURY PARK
Practice Address - State:NJ
Practice Address - Zip Code:07712-5359
Practice Address - Country:US
Practice Address - Phone:732-774-6333
Practice Address - Fax:732-774-0313
Is Sole Proprietor?:No
Enumeration Date:2006-09-20
Last Update Date:2016-01-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ26NN05197900163WC1500X, 363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No163WC1500XNursing Service ProvidersRegistered NurseCommunity Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ0090247Medicaid
NJ0090247Medicaid
NJ219734YZG3Medicare Oscar/Certification