Most Relevant Information
Provider Data
| NPI Number: | 1003560277 |
| Provider Name: | JENNA GLORIA GARDNER CAA |
| Entity Type: | Individual |
| Taxonomy Code: | 367H00000X |
| Specialty: | Anesthesiologist Assistant |
| License Number: | AA2000022 |
Most Important Dates
| Enumeration Date: | 02/07/2022 |
| Last Updated: | 02/06/2024 |
Provider Practice Location
10315 DAWSONS CREEK BLVD STE AB
FORT WAYNE
IN
468251912
Practice Location Phone/Fax
| Phone: | 2604367875 |
| Fax: |
Provider Mailing Location
PO BOX 843603
DALLAS
TX
752843603
Provider Mailing Phone/Fax
| Phone: | 9722331999 |
| Fax: |