Provider Demographics
NPI:1205064375
Name:GARDNER, JACINTA ANNE (RN MSN ACNP)
Entity type:Individual
Prefix:MRS
First Name:JACINTA
Middle Name:ANNE
Last Name:GARDNER
Suffix:
Gender:F
Credentials:RN MSN ACNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:34 PLAINS RD
Mailing Address - Street 2:
Mailing Address - City:HONEOYE FALLS
Mailing Address - State:NY
Mailing Address - Zip Code:14472
Mailing Address - Country:US
Mailing Address - Phone:585-624-4532
Mailing Address - Fax:
Practice Address - Street 1:34 PLAINS RD
Practice Address - Street 2:
Practice Address - City:HONEOYE FALLS
Practice Address - State:NY
Practice Address - Zip Code:14472-9007
Practice Address - Country:US
Practice Address - Phone:585-624-4532
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-06-29
Last Update Date:2023-07-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY430456363LA2100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care