Provider Demographics
NPI:1497181705
Name:GARDNER, DELANA KIM (FNP-C)
Entity Type:Individual
Prefix:MRS
First Name:DELANA
Middle Name:KIM
Last Name:GARDNER
Suffix:
Gender:F
Credentials:FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7002 S CENTRAL AVE
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85042-5423
Mailing Address - Country:US
Mailing Address - Phone:602-499-4221
Mailing Address - Fax:602-268-6298
Practice Address - Street 1:7002 S CENTRAL AVE
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85042-5423
Practice Address - Country:US
Practice Address - Phone:602-499-4221
Practice Address - Fax:602-268-6298
Is Sole Proprietor?:Yes
Enumeration Date:2013-09-18
Last Update Date:2023-04-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZTAP5166363LF0000X
AZAP5166363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ854053Medicaid
Z169792Medicare PIN
AZZ169791Medicare PIN