Healthcare Provider Details

I. General information

NPI: 1447329750
Provider Name (Legal Business Name): DEEDRA R GARRISON PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/08/2006
Last Update Date: 07/02/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5070 HIGHWAY A1A SUITE A
VERO BEACH FL
32963-1400
US

IV. Provider business mailing address

5070 HIGHWAY A1A SUITE A
VERO BEACH FL
32963-1400
US

V. Phone/Fax

Practice location:
  • Phone: 772-234-3700
  • Fax: 772-234-3770
Mailing address:
  • Phone: 772-234-3700
  • Fax: 772-234-3770

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberPA 9106413
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: