Healthcare Provider Details

I. General information

NPI: 1124065347
Provider Name (Legal Business Name): JAN L GARDNER ARNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: JAN LAUGHTON

II. Dates (important events)

Enumeration Date: 05/31/2006
Last Update Date: 05/18/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1350 S HICKORY ST HRMC/HOSPITALIST PROGRAM
MELBOURNE FL
32901-3224
US

IV. Provider business mailing address

PO BOX 561600
ROCKLEDGE FL
32956-1600
US

V. Phone/Fax

Practice location:
  • Phone: 321-434-1771
  • Fax: 321-434-1775
Mailing address:
  • Phone: 321-434-4600
  • Fax: 321-259-0635

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberARNP 2735082
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: