Provider Demographics
NPI:1285682096
Name:GARDNER, NANCY WINDHAM (FNP)
Entity type:Individual
Prefix:
First Name:NANCY
Middle Name:WINDHAM
Last Name:GARDNER
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8351 WESTPORT RD
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32244-5901
Mailing Address - Country:US
Mailing Address - Phone:904-317-8811
Mailing Address - Fax:904-317-4949
Practice Address - Street 1:8351 WESTPORT RD
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32244-5901
Practice Address - Country:US
Practice Address - Phone:904-317-8811
Practice Address - Fax:904-317-4949
Is Sole Proprietor?:No
Enumeration Date:2006-05-04
Last Update Date:2017-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA094149363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA00949825AMedicaid