Active NPI
Timothy F Gardner, NP
- Nurse Practitioner
- Gary, IN
National Provider Identifier
1962466938
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Nurse Practitioner
- License
- 71001772B
- Practice address
- 4802 Broadway
Gary, IN 46408-4509 - Phone
- (219) 887-4950
- NPI assigned
- Apr 14, 2006
- Sex
- Male
- 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 |
|---|---|---|---|---|
| Nurse Practitioner | 363L00000X | 71001772B | IN | Primary |
Addresses
Primary practice location
4802 Broadway
Gary, IN 46408-4509
Mailing address
9900 Bren Rd E
Minnetonka, MN 55343-9664
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 200496760 | Medicaid | IN |
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)
- Enrolled
- Credentials
- Nurse Practitioner
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 71001772B | IN | MD | Nurse Practitioner |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1144972800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1593388800000",
"number": "1962466938",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "9900 BREN RD E",
"city": "MINNETONKA",
"state": "MN",
"postal_code": "553439664"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "4802 BROADWAY",
"city": "GARY",
"state": "IN",
"postal_code": "464084509",
"telephone_number": "219-887-4950"
}
],
"practiceLocations": [],
"basic": {
"last_name": "GARDNER",
"first_name": "TIMOTHY",
"middle_name": "F",
"credential": "NP",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2006-04-14",
"last_updated": "2020-06-29",
"certification_date": "2020-06-29",
"status": "A"
},
"taxonomies": [
{
"code": "363L00000X",
"taxonomy_group": "",
"desc": "Nurse Practitioner",
"state": "IN",
"license": "71001772B",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "200496760",
"state": "IN"
}
],
"endpoints": [],
"other_names": []
}Other providers in Gary, IN
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 29, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.