MEDICARE: MRS. KATHERINE ELIZABETH GARDNER N.P.

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	363LF0000X	Family Nurse Practitioner	RN185338	GA
2	363LF0000X	Family Nurse Practitioner	ARNP9404766	FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1366883209
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. KATHERINE ELIZABETH GARDNER N.P.

Provider Business Mailing Address
First Line	:	12109 COUNTY ROAD 103
Second Line	:
City	:	OXFORD
State	:	FL
Zip	:	34484-2951
Country	:	US
Telephone Number	:	352-205-8981
Fax Number	:	352-391-6498

Provider Business Practice Location Address
First Line	:	240 SOUTHPARK CIR E
Second Line	:
City	:	SAINT AUGUSTINE
State	:	FL
Zip	:	32086-5137
Country	:	US
Telephone Number	:	904-824-1450
Fax Number	:

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

Provider Enumeration Date	:	07/08/2013
Last Update Date	:	01/12/2021

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