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NPI Code Detail

MEDICARE: MRS. CHERYL M GARDNER ARNP

MEDICARE: MRS. CHERYL M GARDNER ARNP
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
1363LP2300XPrimary Care Nurse PractitionerARNP3409302FL
2363L00000XNurse PractitionerARNP3409302FL

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1467586388
Entity Type Code : Individual
Provider Name (Legal Business Name) : MRS. CHERYL M GARDNER ARNP
Provider Business Mailing Address
First Line : 3300 DAIRY RD
Second Line :
City : TITUSVILLE
State : FL
Zip : 32796-1512
Country : US
Telephone Number : 321-267-6687
Fax Number : 321-747-0407
Provider Business Practice Location Address
First Line : 3300 DAIRY RD
Second Line :
City : TITUSVILLE
State : FL
Zip : 32796-1512
Country : US
Telephone Number : 321-267-6687
Fax Number : 321-747-0407
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 03/15/2007
Last Update Date : 06/09/2015

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