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Individual
NICOLE GARRETT
Active
Individual
NICOLE GARRETT
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA-C
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
1619
SC
363A00000X
Physician Assistant
TL1619
SC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
TL1619
MEDICAL STATE LICENSE
SC
Enumeration date
01/25/2011
Last updated
02/10/2020
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