Provider Demographics
NPI:1194107995
Name:GARRETT, EMILY (PA-C)
Entity type:Individual
Prefix:
First Name:EMILY
Middle Name:
Last Name:GARRETT
Suffix:
Gender:
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:800 GOODLETTE ROAD N
Mailing Address - Street 2:SUITE 130
Mailing Address - City:NAPLES
Mailing Address - State:FL
Mailing Address - Zip Code:34102-5402
Mailing Address - Country:US
Mailing Address - Phone:239-649-3333
Mailing Address - Fax:239-649-3386
Practice Address - Street 1:800 GOODLETTE ROAD N
Practice Address - Street 2:SUITE 130
Practice Address - City:NAPLES
Practice Address - State:FL
Practice Address - Zip Code:34102-5402
Practice Address - Country:US
Practice Address - Phone:239-649-3333
Practice Address - Fax:239-649-3386
Is Sole Proprietor?:No
Enumeration Date:2015-06-29
Last Update Date:2025-03-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPA9110162363A00000X, 363A00000X
CT3363363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
No363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLRNSE2OtherBCBS
FL020039600Medicaid