Provider Demographics
NPI:1992784649
Name:GARDENS, JOSE B (PA, CHEABQAURP)
Entity type:Individual
Prefix:DR
First Name:JOSE
Middle Name:B
Last Name:GARDENS
Suffix:
Gender:M
Credentials:PA, CHEABQAURP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5201 WATERFORD DISTRICT DR
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33126-2064
Mailing Address - Country:US
Mailing Address - Phone:786-223-7523
Mailing Address - Fax:786-551-5886
Practice Address - Street 1:1613 HARRISON PKWY
Practice Address - Street 2:#200
Practice Address - City:SUNRISE
Practice Address - State:FL
Practice Address - Zip Code:33323-2853
Practice Address - Country:US
Practice Address - Phone:954-838-2371
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-01-11
Last Update Date:2023-10-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPA9100180363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL758996400Medicaid
FL758996400Medicaid
FLE3447ZMedicare ID - Type Unspecified