Provider Demographics
NPI:1861691644
Name:GARDERE, THERESE FRANCESCA (CPNP)
Entity type:Individual
Prefix:MRS
First Name:THERESE
Middle Name:FRANCESCA
Last Name:GARDERE
Suffix:
Gender:F
Credentials:CPNP
Other - Prefix:MS
Other - First Name:THERESE
Other - Middle Name:FRANCESCA
Other - Last Name:COLLETT
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:CPNP
Mailing Address - Street 1:PO BOX 208058
Mailing Address - Street 2:
Mailing Address - City:NEW HAVEN
Mailing Address - State:CT
Mailing Address - Zip Code:06520-8058
Mailing Address - Country:US
Mailing Address - Phone:203-785-2815
Mailing Address - Fax:203-737-8035
Practice Address - Street 1:747 BELDEN AVE
Practice Address - Street 2:
Practice Address - City:NORWALK
Practice Address - State:CT
Practice Address - Zip Code:06850-3348
Practice Address - Country:US
Practice Address - Phone:914-493-8628
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-07-12
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYF381343-1364SP0200X
CT4397363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics
No364SP0200XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse SpecialistPediatrics