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NPI Code Detail

MEDICARE: JACQUELINE GARDNER FNP

MEDICARE: JACQUELINE GARDNER FNP
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
1363AM0700XMedical Physician AssistantAMD 59HI
2363LP0200XPediatric Nurse PractitionerAPRN 17HI

General Provider Information

NPI Number : 1891920567
Entity Type Code : Individual
Provider Name (Legal Business Name) : JACQUELINE GARDNER FNP
Provider Business Mailing Address
First Line : HC 2 BOX 6074
Second Line :
City : KEAAU
State : HI
Zip : 96749-8300
Country : US
Telephone Number : 808-982-7809
Fax Number :
Provider Business Practice Location Address
First Line : 45 MOHOULI ST
Second Line :
City : HILO
State : HI
Zip : 96720-7210
Country : US
Telephone Number : 808-896-5569
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 05/23/2009
Last Update Date : 10/26/2011

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Directions to “ JACQUELINE GARDNER FNP” Practice Location

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