Provider Demographics
NPI:1689054306
Name:GARDNER, EMILY ELIZABETH (PA-C)
Entity Type:Individual
Prefix:MS
First Name:EMILY
Middle Name:ELIZABETH
Last Name:GARDNER
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Gender:F
Credentials:PA-C
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Mailing Address - Street 1:3040 WILLIAMS DR STE 100
Mailing Address - Street 2:
Mailing Address - City:FAIRFAX
Mailing Address - State:VA
Mailing Address - Zip Code:22031-4618
Mailing Address - Country:US
Mailing Address - Phone:571-350-8400
Mailing Address - Fax:703-940-8692
Practice Address - Street 1:2280 OPITZ BLVD STE 130
Practice Address - Street 2:
Practice Address - City:WOODBRIDGE
Practice Address - State:VA
Practice Address - Zip Code:22191-3362
Practice Address - Country:US
Practice Address - Phone:713-508-4005
Practice Address - Fax:703-897-7938
Is Sole Proprietor?:No
Enumeration Date:2015-06-08
Last Update Date:2024-04-24
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Provider Licenses
StateLicense IDTaxonomies
IN10001831A363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant