Provider Demographics
NPI:1194236521
Name:GARRETT, ELIZABETH NICOLE (APRN)
Entity type:Individual
Prefix:
First Name:ELIZABETH
Middle Name:NICOLE
Last Name:GARRETT
Suffix:
Gender:F
Credentials:APRN
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Other - Middle Name:
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Other - Credentials:
Mailing Address - Street 1:2200 JEFFERSON AVE
Mailing Address - Street 2:5TH FLOOR MERCY PHO/CVO
Mailing Address - City:TOLEDO
Mailing Address - State:OH
Mailing Address - Zip Code:43604-7101
Mailing Address - Country:US
Mailing Address - Phone:419-251-9830
Mailing Address - Fax:419-251-1826
Practice Address - Street 1:1532 LONE OAK RD STE 150
Practice Address - Street 2:
Practice Address - City:PADUCAH
Practice Address - State:KY
Practice Address - Zip Code:42003-7940
Practice Address - Country:US
Practice Address - Phone:270-538-6700
Practice Address - Fax:270-538-6755
Is Sole Proprietor?:No
Enumeration Date:2017-10-12
Last Update Date:2024-09-14
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
KY3011709363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY7100485590Medicaid