Healthcare Provider Details

I. General information

NPI: 1710510987
Provider Name (Legal Business Name): NYSHIA GARCIA PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/17/2020
Last Update Date: 06/14/2024
Certification Date: 06/14/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

865 LINCOLN RD STE 400
BETTENDORF IA
52722-4159
US

IV. Provider business mailing address

200 HAWKINS DR
IOWA CITY IA
52242-1009
US

V. Phone/Fax

Practice location:
  • Phone: 563-344-2240
  • Fax: 563-344-2244
Mailing address:
  • Phone: 563-344-2240
  • Fax: 563-344-2244

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License Number112406
License Number StateIA
# 2
Primary TaxonomyN
Taxonomy Code363AS0400X
TaxonomySurgical Physician Assistant
License Number112406
License Number StateIA
# 3
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number112406
License Number StateIA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: