Basic Information
| Provider Information | |||||||||
| NPI: | 1912210063 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | GARRETT | ||||||||
| FirstName: | ANGELICA | ||||||||
| MiddleName: | THYAIS | ||||||||
| NamePrefix: | DR. | ||||||||
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| Credential: | |||||||||
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| Mailing Information | |||||||||
| Address1: | 1005 DR DB TODD JR BLVD | ||||||||
| Address2: | |||||||||
| City: | NASHVILLE | ||||||||
| State: | TN | ||||||||
| PostalCode: | 372083501 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6153275504 | ||||||||
| FaxNumber: | 6153275541 | ||||||||
| Practice Location | |||||||||
| Address1: | 1005 DR DB TODD JR BLVD | ||||||||
| Address2: | |||||||||
| City: | NASHVILLE | ||||||||
| State: | TN | ||||||||
| PostalCode: | 37208 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6153275504 | ||||||||
| FaxNumber: | 6153275541 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/19/2010 | ||||||||
| LastUpdateDate: | 11/19/2019 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207V00000X | MT198030 | PA | N | Allopathic & Osteopathic Physicians | Obstetrics & Gynecology | 207V00000X | 106376 | MN | N | Allopathic & Osteopathic Physicians | Obstetrics & Gynecology | 207V00000X | 55618 | MN | Y | Allopathic & Osteopathic Physicians | Obstetrics & Gynecology |
ID Information
| ID | Type | State | Issuer | Description | ENROLLED | 05 | MN | MEDICAID | ENROLLED | 05 | IA | MEDICAID |