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General NPI Number Information
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NPI Number | 1679969620
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Entity Type | Individual
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Provider Name | HOLLY ELIZABETH GARDNER PA-C
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Gender | Female
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Dates
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Enumeration Date | 04/07/2015
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Last Update Date | 03/10/2025
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Provider Practice Location Address
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Address Line | 280 CHESTNUT ST FL 2
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City | SPRINGFIELD
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State | MA
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Zip | 01199-0002
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Country | US
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Telephone | 413-794-7873
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Fax | 413-794-1629
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Provider Business Mailing Address
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Address Line | 345 QUADDICK RD
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City | THOMPSON
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State | CT
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Zip | 06277-2912
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Country | US
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Telephone | 860-942-7377
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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 | 363AS0400X
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Taxonomy Name | Surgical Physician Assistant
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License Number | PA5302
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License Number State | MA
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Taxonomy #2
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Taxonomy Code | 207RG0100X
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Taxonomy Name | Gastroenterology Physician
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License Number | PA5302
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License Number State | MA
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Taxonomy #3
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Taxonomy Code | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number | PA5302
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License Number State | MA
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