Healthcare Provider Details

I. General information

NPI: 1336850387
Provider Name (Legal Business Name): NIKITA GARRETT FNP-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/12/2022
Last Update Date: 04/09/2023
Certification Date: 04/09/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4350 N 19TH AVE STE 6
PHOENIX AZ
85015-4602
US

IV. Provider business mailing address

233 E SOUTHERN AVE #26159
TEMPE AZ
85282
US

V. Phone/Fax

Practice location:
  • Phone: 602-264-9191
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number282936
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: