Healthcare Provider Details

I. General information

NPI: 1205990983
Provider Name (Legal Business Name): TABITHA T GARRISON FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/20/2006
Last Update Date: 01/29/2021
Certification Date: 01/29/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

173 EAST SPRINGBROOK ROAD
BROADWAY VA
22815
US

IV. Provider business mailing address

173 EAST SPRINGBROOK ROAD
BROADWAY VA
22815
US

V. Phone/Fax

Practice location:
  • Phone: 540-901-7028
  • Fax: 540-901-2599
Mailing address:
  • Phone: 540-901-7028
  • Fax: 540-901-2599

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207QH0002X
TaxonomyHospice and Palliative Medicine (Family Medicine) Physician
License Number0024167218
License Number StateVA
# 2
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number0024167218
License Number StateVA
# 3
Primary TaxonomyY
Taxonomy Code208VP0000X
TaxonomyPain Medicine Physician
License Number0024167218
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: