MEDICARE: ROSALYN DENAYE GARRETT FNP

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	363LF0000X	Family Nurse Practitioner	0024181406	VA

General Provider Information

NPI Number	:	1588309785
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ROSALYN DENAYE GARRETT FNP

Provider Business Mailing Address
First Line	:	305 APPLEWOOD CT
Second Line	:
City	:	SUFFOLK
State	:	VA
Zip	:	23434-2513
Country	:	US
Telephone Number	:	757-692-2787
Fax Number	:

Provider Business Practice Location Address
First Line	:	1540 BREEZEPORT WAY STE 100
Second Line	:
City	:	SUFFOLK
State	:	VA
Zip	:	23435-3752
Country	:	US
Telephone Number	:	757-744-9044
Fax Number	:

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

Provider Enumeration Date	:	05/02/2022
Last Update Date	:	05/02/2022

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