Provider Demographics
NPI:1629694443
Name:GARDNER, DARREN RASHAUD
Entity Type:Individual
Prefix:
First Name:DARREN
Middle Name:RASHAUD
Last Name:GARDNER
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9132 JENNIFER BLVD
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32222-1928
Mailing Address - Country:US
Mailing Address - Phone:904-330-6070
Mailing Address - Fax:
Practice Address - Street 1:9132 JENNIFER BLVD
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32222-1928
Practice Address - Country:US
Practice Address - Phone:904-330-6070
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-06-17
Last Update Date:2020-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes347E00000XTransportation ServicesTransportation Broker