Provider Demographics
NPI:1942635016
Name:GARDNER, SARAH
Entity Type:Individual
Prefix:
First Name:SARAH
Middle Name:
Last Name:GARDNER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:SARAH
Other - Middle Name:
Other - Last Name:ROCROU
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:21824 WAVERLY SHORES LN
Mailing Address - Street 2:
Mailing Address - City:LAND O LAKES
Mailing Address - State:FL
Mailing Address - Zip Code:34637-7562
Mailing Address - Country:US
Mailing Address - Phone:650-814-2559
Mailing Address - Fax:
Practice Address - Street 1:4800 ROWAN RD
Practice Address - Street 2:
Practice Address - City:NEW PORT RICHEY
Practice Address - State:FL
Practice Address - Zip Code:34653-5609
Practice Address - Country:US
Practice Address - Phone:727-483-5912
Practice Address - Fax:727-376-3652
Is Sole Proprietor?:No
Enumeration Date:2013-09-09
Last Update Date:2021-06-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL9367638363LX0001X
FLARNP9367638363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No363LX0001XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerObstetrics & Gynecology