Healthcare Provider Details

I. General information

NPI: 1609384205
Provider Name (Legal Business Name): ELIZABETH GARRETT NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/17/2018
Last Update Date: 04/30/2026
Certification Date: 04/30/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1008 LAKE MURRAY BLVD
IRMO SC
29063-2821
US

IV. Provider business mailing address

3882 ALAFAYA LN UNIT 108
ROCKLEDGE FL
32955-5415
US

V. Phone/Fax

Practice location:
  • Phone: 803-749-3845
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number2017039080
License Number StateMO
# 2
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number30320
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: