Provider Demographics
NPI:1437713138
Name:GARDNER, ANGELA (CRNP)
Entity Type:Individual
Prefix:MRS
First Name:ANGELA
Middle Name:
Last Name:GARDNER
Suffix:
Gender:F
Credentials:CRNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1502 5TH AVE S
Mailing Address - Street 2:
Mailing Address - City:BIRMINGHAM
Mailing Address - State:AL
Mailing Address - Zip Code:35233-1615
Mailing Address - Country:US
Mailing Address - Phone:205-719-5785
Mailing Address - Fax:205-719-5786
Practice Address - Street 1:1502 5TH AVE S
Practice Address - Street 2:
Practice Address - City:BIRMINGHAM
Practice Address - State:AL
Practice Address - Zip Code:35233-1615
Practice Address - Country:US
Practice Address - Phone:205-719-5785
Practice Address - Fax:205-719-5786
Is Sole Proprietor?:No
Enumeration Date:2019-04-28
Last Update Date:2019-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL1-084130363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics