Provider Demographics
NPI:1679969620
Name:GARDNER, HOLLY ELIZABETH (PA-C)
Entity type:Individual
Prefix:
First Name:HOLLY
Middle Name:ELIZABETH
Last Name:GARDNER
Suffix:
Gender:
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:345 QUADDICK RD
Mailing Address - Street 2:
Mailing Address - City:THOMPSON
Mailing Address - State:CT
Mailing Address - Zip Code:06277-2912
Mailing Address - Country:US
Mailing Address - Phone:860-942-7377
Mailing Address - Fax:
Practice Address - Street 1:280 CHESTNUT ST FL 2
Practice Address - Street 2:
Practice Address - City:SPRINGFIELD
Practice Address - State:MA
Practice Address - Zip Code:01199-0002
Practice Address - Country:US
Practice Address - Phone:413-794-7873
Practice Address - Fax:413-794-1629
Is Sole Proprietor?:No
Enumeration Date:2015-04-07
Last Update Date:2025-03-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MAPA5302363AS0400X, 207RG0100X, 363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
No363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical
No207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology