=====================================================
General NPI Number Information
=====================================================
NPI Number | 1144533522
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | TAMMY JOY GARRETT PA-C
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 07/14/2010
-----------------------------------------------------
Last Update Date | 01/30/2021
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 3920 N UNION BLVD # 220
-----------------------------------------------------
City | COLORADO SPRINGS
-----------------------------------------------------
State | CO
-----------------------------------------------------
Zip | 80907-4900
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 719-375-5400
-----------------------------------------------------
Fax | 719-434-7474
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 3246 CHERRY PLUM PL
-----------------------------------------------------
City | CASTLE ROCK
-----------------------------------------------------
State | CO
-----------------------------------------------------
Zip | 80104-2737
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 719-323-1644
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 363A00000X
-----------------------------------------------------
Taxonomy Name | Physician Assistant
-----------------------------------------------------
License Number | 0003476
-----------------------------------------------------
License Number State | CO
-----------------------------------------------------