Healthcare Provider Details

I. General information

NPI: 1992130132
Provider Name (Legal Business Name): ANTONIA GARNER FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/06/2013
Last Update Date: 12/20/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1320 LAS TABLAS RD STE B
TEMPLETON CA
93465-9711
US

IV. Provider business mailing address

2285 CORPORATE CIR STE 200
HENDERSON NV
89074-7759
US

V. Phone/Fax

Practice location:
  • Phone: 805-434-5563
  • Fax:
Mailing address:
  • Phone: 805-434-5916
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number23390
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: