Healthcare Provider Details

I. General information

NPI: 1972485712
Provider Name (Legal Business Name): MADISON GARDNER DNP, APRN-CNS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/23/2025
Last Update Date: 07/23/2025
Certification Date: 07/23/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2512 25TH CT
JUPITER FL
33477-9332
US

IV. Provider business mailing address

2512 25TH CT
JUPITER FL
33477-9332
US

V. Phone/Fax

Practice location:
  • Phone: 614-816-3276
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code364SA2200X
TaxonomyAdult Health Clinical Nurse Specialist
License Number11038954
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: