Provider Demographics
NPI:1700989894
Name:NARDIN, GARY S (RPA-C)
Entity Type:Individual
Prefix:MR
First Name:GARY
Middle Name:S
Last Name:NARDIN
Suffix:
Gender:M
Credentials:RPA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1805 WILLIAMSON CT
Mailing Address - Street 2:
Mailing Address - City:BRENTWOOD
Mailing Address - State:TN
Mailing Address - Zip Code:37027-8164
Mailing Address - Country:US
Mailing Address - Phone:615-331-5536
Mailing Address - Fax:615-331-3859
Practice Address - Street 1:1805 WILLIAMSON CT
Practice Address - Street 2:
Practice Address - City:BRENTWOOD
Practice Address - State:TN
Practice Address - Zip Code:37027-8164
Practice Address - Country:US
Practice Address - Phone:615-331-5536
Practice Address - Fax:615-331-3859
Is Sole Proprietor?:No
Enumeration Date:2006-09-06
Last Update Date:2021-01-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY003344363A00000X
TN2386363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
TNQ014868Medicaid
NY089562OtherMVP HEALTHCARE
NY000495302004OtherBSNENY
NY02216580Medicaid
NY02216580Medicaid
NYCC6890Medicare ID - Type Unspecified