Provider Demographics
NPI:1609275254
Name:GARDNER, AMIE MARIE (APRN, FNP-BC)
Entity Type:Individual
Prefix:
First Name:AMIE
Middle Name:MARIE
Last Name:GARDNER
Suffix:
Gender:F
Credentials:APRN, FNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:132 HIGHLAND OAKS CT S
Mailing Address - Street 2:
Mailing Address - City:SAINT MARYS
Mailing Address - State:GA
Mailing Address - Zip Code:31558-2603
Mailing Address - Country:US
Mailing Address - Phone:912-409-3034
Mailing Address - Fax:
Practice Address - Street 1:132 HIGHLAND OAKS CT S
Practice Address - Street 2:
Practice Address - City:SAINT MARYS
Practice Address - State:GA
Practice Address - Zip Code:31558-2603
Practice Address - Country:US
Practice Address - Phone:912-409-3034
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-08-20
Last Update Date:2019-01-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA230753363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner