MEDICARE: REBECCA R GARRETT PA

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	390200000X	Student in an Organized Health Care Education/Training Program
2	363A00000X	Physician Assistant	0110008123	VA

General Provider Information

NPI Number	:	1063091007
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	REBECCA R GARRETT PA

Provider Business Mailing Address
First Line	:	3241 WESTERN BRANCH BLVD STE A
Second Line	:
City	:	CHESAPEAKE
State	:	VA
Zip	:	23321-5260
Country	:	US
Telephone Number	:	757-686-3508
Fax Number	:	757-686-0541

Provider Business Practice Location Address
First Line	:	2088 S INDEPENDENCE BLVD STE 103
Second Line	:
City	:	VIRGINIA BEACH
State	:	VA
Zip	:	23453-4790
Country	:	US
Telephone Number	:	757-275-9331
Fax Number	:	757-416-7656

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/06/2021
Last Update Date	:	11/03/2022

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