| NPI | 1851763676 |
|---|---|
| Former Name | DESIRAE NICOLE GARDINER |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: CA PA52952) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: FL 285) |
| 363A00000X Physician Assistant (Licence: NY 028264-01) | |
| 363A00000X Physician Assistant (Licence: AZ 10772) | |
| 363A00000X Physician Assistant (Licence: NV PA3264) | |
| 363A00000X Physician Assistant (Licence: FL PA9119701) | |
| 363A00000X Physician Assistant (Licence: CA 52952) | |
| 363A00000X Physician Assistant (Licence: CO PA0008942) | |
| Enumeration Date | 2015-10-21 |
| Last Update Date | 2025-10-15 |