Provider Demographics
NPI:1760400816
Name:GARDNER, NANCY MARIE (APRN)
Entity type:Individual
Prefix:
First Name:NANCY
Middle Name:MARIE
Last Name:GARDNER
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:943 S BENEVA RD STE 306
Mailing Address - Street 2:
Mailing Address - City:SARASOTA
Mailing Address - State:FL
Mailing Address - Zip Code:34232-2473
Mailing Address - Country:US
Mailing Address - Phone:941-955-1108
Mailing Address - Fax:941-954-4440
Practice Address - Street 1:2881 HYDE PARK ST
Practice Address - Street 2:
Practice Address - City:SARASOTA
Practice Address - State:FL
Practice Address - Zip Code:34239-3228
Practice Address - Country:US
Practice Address - Phone:941-957-4767
Practice Address - Fax:941-955-7334
Is Sole Proprietor?:No
Enumeration Date:2006-07-17
Last Update Date:2025-04-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLARNP1322062363L00000X
FLAPRN1322062363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL305781000Medicaid
FL305781000Medicaid
FLY033ROtherBCBS
FLP96322Medicare UPIN
FL305781000Medicaid