Active NPI
Susan Gambardella
- Pharmacist
- Ponte Vedra Beach, FL
National Provider Identifier
1184215618
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Pharmacist
- License
- PS22729
- Practice address
- 290 Solana Rd
Ponte Vedra Beach, FL 32082-2234 - Phone
- (904) 543-8678
- NPI assigned
- Jan 28, 2021
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Pharmacist | 183500000X | PS22729 | FL | Primary |
Addresses
Primary practice location
290 Solana Rd
Ponte Vedra Beach, FL 32082-2234
Mailing address
14036 Carson CT
Jacksonville, FL 32224-0868
Phone (904) 868-5146
Other names 1
- Susan Wilson
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| PS22729 | FL | MD | Pharmacist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1611792000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1611792000000",
"number": "1184215618",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "14036 CARSON CT",
"city": "JACKSONVILLE",
"state": "FL",
"postal_code": "322240868",
"telephone_number": "904-868-5146"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "290 SOLANA RD",
"city": "PONTE VEDRA BEACH",
"state": "FL",
"postal_code": "320822234",
"telephone_number": "904-543-8678"
}
],
"practiceLocations": [],
"basic": {
"last_name": "GAMBARDELLA",
"first_name": "SUSAN",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2021-01-28",
"last_updated": "2021-01-28",
"certification_date": "2021-01-28",
"status": "A"
},
"taxonomies": [
{
"code": "183500000X",
"taxonomy_group": "",
"desc": "Pharmacist",
"state": "FL",
"license": "PS22729",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": [
{
"first_name": "SUSAN",
"last_name": "WILSON",
"code": "1",
"type": "Former Name"
}
]
}Other providers in Ponte Vedra Beach, FL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 28, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.