Basic Information
| Provider Information | |||||||||
| NPI: | 1013198530 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | GARRETT | ||||||||
| FirstName: | RENEE | ||||||||
| MiddleName: | K | ||||||||
| NamePrefix: | MS. | ||||||||
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| Credential: | MHS, PA-C | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 734905 | ||||||||
| Address2: | |||||||||
| City: | DALLAS | ||||||||
| State: | TX | ||||||||
| PostalCode: | 753734905 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9044497246 | ||||||||
| FaxNumber: | 9047197571 | ||||||||
| Practice Location | |||||||||
| Address1: | 4796 HODGES BLVD STE 101 | ||||||||
| Address2: | |||||||||
| City: | JACKSONVILLE | ||||||||
| State: | FL | ||||||||
| PostalCode: | 322242209 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9044497246 | ||||||||
| FaxNumber: | 9047197571 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 11/27/2007 | ||||||||
| LastUpdateDate: | 03/16/2021 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 03/16/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363AS0400X | PA9105431 | FL | Y | Physician Assistants & Advanced Practice Nursing Providers | Physician Assistant | Surgical |
No ID Information.