Provider Demographics
NPI:1295734333
Name:GARDNER, ELIZABETH (APRN, DNP)
Entity type:Individual
Prefix:
First Name:ELIZABETH
Middle Name:
Last Name:GARDNER
Suffix:
Gender:F
Credentials:APRN, DNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13013 SWEET BAY DR
Mailing Address - Street 2:
Mailing Address - City:EULESS
Mailing Address - State:TX
Mailing Address - Zip Code:76040-7181
Mailing Address - Country:US
Mailing Address - Phone:214-783-1489
Mailing Address - Fax:
Practice Address - Street 1:601 N INDUSTRIAL BLVD
Practice Address - Street 2:
Practice Address - City:BEDFORD
Practice Address - State:TX
Practice Address - Zip Code:76021-5234
Practice Address - Country:US
Practice Address - Phone:817-283-0161
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-07-20
Last Update Date:2019-01-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXAP106039363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX060559402Medicaid
TX060559403Medicaid
TX060559404Medicaid
TX8N4809OtherBLUE CROSS BLUE SHIELD
82N984Medicare PIN
TXS83336Medicare UPIN
8K3026Medicare PIN