Healthcare Provider Details

I. General information

NPI: 1215709472
Provider Name (Legal Business Name): CHRISANTHE RENA GARILAS APRN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/23/2023
Last Update Date: 10/15/2024
Certification Date: 10/15/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

765 HAYWOOD RD
GREENVILLE SC
29607-2772
US

IV. Provider business mailing address

20 OVERBROOK CT APT 107
GREENVILLE SC
29607-1369
US

V. Phone/Fax

Practice location:
  • Phone: 864-520-2020
  • Fax: 864-640-4400
Mailing address:
  • Phone: 603-327-7498
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number285520
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: