Healthcare Provider Details

I. General information

NPI: 1407954290
Provider Name (Legal Business Name): PATRICIA R GARDUNO APN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/20/2006
Last Update Date: 01/28/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1301 MAIN ST
ASBURY PARK NJ
07712-5359
US

IV. Provider business mailing address

1301 MAIN ST
ASBURY PARK NJ
07712-5359
US

V. Phone/Fax

Practice location:
  • Phone: 732-774-6333
  • Fax: 732-774-0313
Mailing address:
  • Phone: 732-774-6333
  • Fax: 732-774-0313

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163WC1500X
TaxonomyCommunity Health Registered Nurse
License Number26NN05197900
License Number StateNJ
# 2
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number26NN05197900
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: