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General NPI Number Information
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NPI Number | 1689054306
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Entity Type | Individual
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Provider Name | EMILY ELIZABETH GARDNER PA-C
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Gender | Female
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Dates
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Enumeration Date | 06/08/2015
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Last Update Date | 11/10/2025
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Provider Practice Location Address
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Address Line | 9450 INNOVATION DR
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City | MANASSAS
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State | VA
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Zip | 20110-2214
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Country | US
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Telephone | 571-350-8400
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Fax | 571-222-2202
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Provider Business Mailing Address
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Address Line | 3040 WILLIAMS DR STE 100
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City | FAIRFAX
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State | VA
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Zip | 22031-4618
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Country | US
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Telephone | 571-350-8400
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Fax | 571-222-2202
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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 | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number | 0110005373
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License Number State | VA
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Taxonomy #2
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Taxonomy Code | 363AM0700X
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Taxonomy Name | Medical Physician Assistant
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License Number | 0110005373
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License Number State | VA
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