Provider Demographics
NPI:1336375468
Name:GARDNER, TARIN KADYNE (RN)
Entity Type:Individual
Prefix:MISS
First Name:TARIN
Middle Name:KADYNE
Last Name:GARDNER
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:136 STRINGHAM RD
Mailing Address - Street 2:APT 11F
Mailing Address - City:LAGRANGEVILLE
Mailing Address - State:NY
Mailing Address - Zip Code:12540-5522
Mailing Address - Country:US
Mailing Address - Phone:845-309-9377
Mailing Address - Fax:
Practice Address - Street 1:136 STRINGHAM RD
Practice Address - Street 2:11F
Practice Address - City:LAGRANGEVILLE
Practice Address - State:NY
Practice Address - Zip Code:12540-5522
Practice Address - Country:US
Practice Address - Phone:845-309-9377
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-06-03
Last Update Date:2014-09-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY648325163W00000X
NY269416164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse
Yes163W00000XNursing Service ProvidersRegistered Nurse