Provider Demographics
NPI:1942523071
Name:GARDINER, ROBIN E (FNP)
Entity Type:Individual
Prefix:
First Name:ROBIN
Middle Name:E
Last Name:GARDINER
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:ROBIN
Other - Middle Name:
Other - Last Name:TANNER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:NP
Mailing Address - Street 1:6626 E 75TH ST STE 500
Mailing Address - Street 2:
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46250-2890
Mailing Address - Country:US
Mailing Address - Phone:317-621-7584
Mailing Address - Fax:
Practice Address - Street 1:8102 CLEARVISTA PKWY
Practice Address - Street 2:
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46256-1661
Practice Address - Country:US
Practice Address - Phone:317-849-8222
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-03-03
Last Update Date:2022-09-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN71003166A363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN200976220Medicaid
IN220890004Medicare PIN
IN200976220Medicaid