Individual
JACOB RYAN GARDNER
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PA
Contact information
Practice address
18167 US HIGHWAY 19 N STE 150, CLEARWATER, FL 33764-6566
(727) 321-3854
Mailing address
701 94TH AVE N STE 250, ST PETERSBURG, FL 33702-2448
(727) 321-3854
Taxonomy
Speciality
Code
Description
License number
State
363AM0700X
Medical Physician Assistant
Primary
PA9118395
FL
Other
Enumeration date
02/01/2024
Last updated
03/27/2024
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