Healthcare Provider Details

I. General information

NPI: 1699194746
Provider Name (Legal Business Name): TERESA GARRIS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/15/2014
Last Update Date: 01/07/2025
Certification Date: 01/07/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1018 WATERMAN AVE
EAST PROVIDENCE RI
02914-1318
US

IV. Provider business mailing address

1018 WATERMAN AVE
EAST PROVIDENCE RI
02914-1318
US

V. Phone/Fax

Practice location:
  • Phone: 401-231-0450
  • Fax: 401-233-2387
Mailing address:
  • Phone: 401-231-0450
  • Fax: 401-233-2387

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License NumberNPP37871
License Number StateRI
# 2
Primary TaxonomyN
Taxonomy Code363LG0600X
TaxonomyGerontology Nurse Practitioner
License NumberNPP37871
License Number StateRI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: