Provider Demographics
NPI:1912191826
Name:ALBU-GARDNER, NIKKI E (PA)
Entity Type:Individual
Prefix:MS
First Name:NIKKI
Middle Name:E
Last Name:ALBU-GARDNER
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2797 JACKSON BLUFF RD
Mailing Address - Street 2:
Mailing Address - City:MARIANNA
Mailing Address - State:FL
Mailing Address - Zip Code:32446-7827
Mailing Address - Country:US
Mailing Address - Phone:850-718-7659
Mailing Address - Fax:
Practice Address - Street 1:2797 JACKSON BLUFF RD
Practice Address - Street 2:
Practice Address - City:MARIANNA
Practice Address - State:FL
Practice Address - Zip Code:32446-7827
Practice Address - Country:US
Practice Address - Phone:850-718-7659
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-09-04
Last Update Date:2013-01-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPA9101074363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical