Provider Demographics
NPI:1215713045
Name:GARRETT, REKIA (SLC)
Entity type:Individual
Prefix:
First Name:REKIA
Middle Name:
Last Name:GARRETT
Suffix:
Gender:F
Credentials:SLC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 8104
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32239-0104
Mailing Address - Country:US
Mailing Address - Phone:323-313-4546
Mailing Address - Fax:
Practice Address - Street 1:2905 FRUITWOOD LN
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32277-3614
Practice Address - Country:US
Practice Address - Phone:323-313-4546
Practice Address - Fax:904-212-0252
Is Sole Proprietor?:No
Enumeration Date:2023-09-07
Last Update Date:2023-09-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171400000XOther Service ProvidersHealth & Wellness Coach
No171M00000XOther Service ProvidersCase Manager/Care Coordinator
No374U00000XNursing Service Related ProvidersHome Health Aide
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL024730500Medicaid