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General NPI Number Information
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NPI Number | 1649020058
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Entity Type | Individual
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Provider Name | JANELLE SHERIDAN GARDNER
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Gender | Female
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Dates
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Enumeration Date | 03/26/2024
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Last Update Date | 04/02/2025
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Provider Practice Location Address
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Address Line | 5533 SW 64TH ST
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City | GAINESVILLE
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State | FL
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Zip | 32608-9608
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Country | US
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Telephone | 352-271-5967
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Fax | 352-271-5968
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Provider Business Mailing Address
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Address Line | 13822 N STATE ROAD 121
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City | MACCLENNY
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State | FL
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Zip | 32063-4370
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Country | US
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Telephone | 904-514-3285
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Fax |
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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 | 152W00000X
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Taxonomy Name | Optometrist
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License Number | 6481
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License Number State | FL
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