Mario Gardner, APRN
Individual provider Active NPI Nurse Practitioner · Destin, FL
NPI 1679117451 · NPPES record last updated Feb 15, 2024
Key facts
- NPI
- 1679117451
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Nurse Practitioner 363L00000X
- License
- APRN11006004 (FL)
- Practice address
- 137 Crystal Beach Dr Ste 121
Destin, FL 32541-3573 - Phone
- (850) 807-4388
- Fax
- (850) 862-0605
- NPI assigned
- Nov 4, 2019
- Sex
- Male
- Sole proprietor
- No
Organizations & group practices 14
Hospital & facility affiliations 2
Medicare Care Compare profile
- Specialty
- Nurse Practitioner
- Education
- Other, 2019
- Medicare assignment
- May accept Medicare assignment
- Group practices
- Icare Mobile Medicine, LLC
Gulf Coast Pain Consultants LLC
Ibrahim Heart Clinic PLLC
Practice addresses (Care Compare)
2525 Embassy Dr
Suite 5
Hollywood, FL 33026-4573
Phone (786) 661-7830
3810 Hwy 90
Pace, FL 32571-1014
Phone (850) 484-4080
408 Medical Park Dr
Atmore, AL 36502-3016
Phone (855) 527-7246
5150 Belfort Rd
BLDG 400
Jacksonville, FL 32256-6026
Phone (904) 580-4730
Hospital & facility affiliations
- Baptist Hospital
- Santa Rosa Medical Center
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled (2 enrollments) in FL, AL
- Eligible to order & refer
- Part B services: Yes · DME: Yes · Home health: Yes · Power mobility devices: Yes · Hospice: No
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20200329000151 | FL | Practitioner - Nurse Practitioner | 4688003510 | Reassigns benefits to 3 organizations |
| I20210921001966 | AL | Practitioner - Nurse Practitioner | 4688003510 | Reassigns benefits to 2 organizations |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
- Credentials
- Nurse Practitioner
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| RN9265919 | FL | MD | Registered Nurse |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Gulf Coast Pain Consultants LLC | Current | Accepting new patients | |
| Ibrahim Heart Clinic PLLC | Current |
Accepting new patients | |
| Gulf Coast Pain Consultants LLC | Current |
Accepting new patients | |
| Gulf Coast Pain Consultants LLC | Current |
Accepting new patients | |
| Icare Mobile Medicine LLC | Current |
Accepting new patients | |
| Gulf Coast Pain Consultants LLC | Current |
Accepting new patients | |
| Healogics Specialty Physicians of Alabama, LLC | Undersea and Hyperbaric Medicine | Current |
Accepting new patients |
| Advanced Wound Systems LLC | Past | Accepting new patients |
Locations
3316 Highway 280
Alexander City, AL 35010
Phone (256) 329-7100
135 Medical Park Dr
Ste 2B
Andalusia, AL 36420
Phone (850) 753-8075
408 Medical Park Dr
Atmore, AL 36502
Phone (251) 368-2550
215 S US Highway 17
East Palatka, FL 32131
Phone (386) 232-9203
2525 Embassy Dr
Ste 5
Hollywood, FL 33026
Phone (786) 661-7830
5150 Belfort Rd
Bldg 400
Jacksonville, FL 32256
Phone (904) 296-0900
5220 Belfort Rd
Ste 130
Jacksonville, FL 32256
Phone (904) 446-3686
1125 Fleming Plantation Blvd
Orange Park, FL 32003
Phone (904) 245-7620
3810 Highway 90
Pace, FL 32571
Phone (850) 476-9000
4901 Market Place Rd
Pensacola, FL 32504
Phone (850) 439-5425
5102 N Davis Hwy
Pensacola, FL 32503
Phone (850) 484-8800
1040 Gulf Breeze Pkwy
Pensacola Beach, FL 32561
Phone (850) 438-6555
319 W Call St
Ste B
Starke, FL 32091
Phone (904) 368-9102
Interoperability endpoints
- mario.gardner.1@11679.direct.athenahealth.com
- mgardner@cvi.curemd.direct-ci.com
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Nurse Practitioner | 363L00000X | APRN11006004 | FL | Yes |
| Registered Nurse | 163W00000X | RN9265919 | FL | |
| Undersea and Hyperbaric Medicine (Preventive Medicine) Physician | 2083P0011X | APRN11006004 | FL |
Addresses
Primary practice location
137 Crystal Beach Dr Ste 121
Destin, FL 32541-3573
Mailing address
917 Mar Walt Dr
Fort Walton Beach, FL 32547-6651
Phone (508) 623-9798
Other practice location 1
917 Mar Walt Dr
Fort Walton Beach, FL 32547-6651
Phone (850) 862-3979
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 105938800 | Medicaid | FL |
Other providers in Destin, FL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Feb 15, 2024. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Order and Referring (CMS).
- Medicare Care Compare provider data (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.