Provider Demographics
NPI:1760400816
Name:GARDNER, NANCY MARIE (APRN)
Entity Type:Individual
Prefix:
First Name:NANCY
Middle Name:MARIE
Last Name:GARDNER
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4919 MEMORIAL HWY STE 150
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33634-7516
Mailing Address - Country:US
Mailing Address - Phone:813-333-1512
Mailing Address - Fax:813-333-1561
Practice Address - Street 1:1801 S OSPREY AVE UNIT 201
Practice Address - Street 2:
Practice Address - City:SARASOTA
Practice Address - State:FL
Practice Address - Zip Code:34239-3625
Practice Address - Country:US
Practice Address - Phone:941-957-4767
Practice Address - Fax:941-955-7334
Is Sole Proprietor?:No
Enumeration Date:2006-07-17
Last Update Date:2023-02-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLARNP1322062363L00000X
FLAPRN1322062363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL305781000Medicaid
FL305781000Medicaid
FLY033ROtherBCBS
FLP96322Medicare UPIN
FL305781000Medicaid