Provider Demographics
NPI:1932778917
Name:GARCIA, MICHAEL
Entity type:Individual
Prefix:
First Name:MICHAEL
Middle Name:
Last Name:GARCIA
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1577 C ST, STE 105
Mailing Address - Street 2:916730
Mailing Address - City:ANCHORAGE
Mailing Address - State:AK
Mailing Address - Zip Code:99501-5127
Mailing Address - Country:US
Mailing Address - Phone:907-891-8093
Mailing Address - Fax:
Practice Address - Street 1:1577 C ST, STE 105
Practice Address - Street 2:916730
Practice Address - City:ANCHORAGE
Practice Address - State:AK
Practice Address - Zip Code:99501-5127
Practice Address - Country:US
Practice Address - Phone:907-891-8093
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-06-23
Last Update Date:2024-06-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NDR50316363LF0000X
HIAPRN-3126363LF0000X
TX1088207363LF0000X
AK218673363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily