MEDICARE: MARCIA GARDENER

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	374U00000X	Home Health Aide		FL

General Provider Information

NPI Number	:	1144039629
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MARCIA GARDENER

Provider Business Mailing Address
First Line	:	288 LAS PALMAS ST
Second Line	:
City	:	ROYAL PALM BEACH
State	:	FL
Zip	:	33411-1323
Country	:	US
Telephone Number	:	561-628-6646
Fax Number	:

Provider Business Practice Location Address
First Line	:	288 LAS PALMAS ST
Second Line	:
City	:	ROYAL PALM BEACH
State	:	FL
Zip	:	33411-1323
Country	:	US
Telephone Number	:	561-628-6646
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	12/30/2024
Last Update Date	:	12/30/2024

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