Provider Demographics
NPI:1669501789
Name:COLEMAN-GARDELLA, PATRICIA ELLEN (ARNP, BC)
Entity Type:Individual
Prefix:MS
First Name:PATRICIA
Middle Name:ELLEN
Last Name:COLEMAN-GARDELLA
Suffix:
Gender:F
Credentials:ARNP, BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:59 CARRIAGE DR
Mailing Address - Street 2:
Mailing Address - City:CRAWFORDVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32327-2496
Mailing Address - Country:US
Mailing Address - Phone:850-926-8594
Mailing Address - Fax:
Practice Address - Street 1:1616 PHYSICIANS DR
Practice Address - Street 2:
Practice Address - City:TALLAHASSEE
Practice Address - State:FL
Practice Address - Zip Code:32308-4619
Practice Address - Country:US
Practice Address - Phone:850-431-5110
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-03-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL9229390363LF0000X
NYF331525-1363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily