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General NPI Number Information
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NPI Number | 1366883209
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Entity Type | Individual
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Provider Name | KATHERINE ELIZABETH GARDNER N.P.
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Gender | Female
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Dates
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Enumeration Date | 07/08/2013
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Last Update Date | 01/12/2021
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Provider Practice Location Address
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Address Line | 240 SOUTHPARK CIR E
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City | SAINT AUGUSTINE
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State | FL
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Zip | 32086-5137
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Country | US
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Telephone | 904-824-1450
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Fax |
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Provider Business Mailing Address
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Address Line | 12109 COUNTY ROAD 103
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City | OXFORD
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State | FL
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Zip | 34484-2951
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Country | US
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Telephone | 352-205-8981
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Fax | 352-391-6498
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | RN185338
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License Number State | GA
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Taxonomy #2
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | ARNP9404766
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License Number State | FL
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