MEDICARE: JEREMY GARDNER PMHNP

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363LP0808X	Psychiatric/Mental Health Nurse Practitioner	C-APN.0105259-C-NP	CO

General Provider Information

NPI Number	:	1073483889
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JEREMY GARDNER PMHNP

Provider Business Mailing Address
First Line	:	2695 ROCKY MOUNTAIN AVE STE 260
Second Line	:
City	:	LOVELAND
State	:	CO
Zip	:	80538-9075
Country	:	US
Telephone Number	:	720-712-0306
Fax Number	:

Provider Business Practice Location Address
First Line	:	2695 ROCKY MOUNTAIN AVE STE 260
Second Line	:
City	:	LOVELAND
State	:	CO
Zip	:	80538-9075
Country	:	US
Telephone Number	:	720-712-0306
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	11/06/2025
Last Update Date	:	04/13/2026

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