Healthcare Provider Details

I. General information

NPI: 1689837627
Provider Name (Legal Business Name): ERIKA A. GARRISON PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/09/2008
Last Update Date: 10/15/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6100 KENNERLY RD BAHRI ORTHOPEDICS
JACKSONVILLE FL
32216-4368
US

IV. Provider business mailing address

129 11TH AVE N APT A
JACKSONVILLE BEACH FL
32250-8213
US

V. Phone/Fax

Practice location:
  • Phone: 904-739-0050
  • Fax:
Mailing address:
  • Phone: 219-928-3916
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number085003237
License Number StateIL
# 2
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberPA9107156
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: