Provider Demographics
NPI:1447329750
Name:GARRISON, DEEDRA R (PA-C)
Entity type:Individual
Prefix:MS
First Name:DEEDRA
Middle Name:R
Last Name:GARRISON
Suffix:
Gender:F
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 1:5070 HIGHWAY A1A
Mailing Address - Street 2:SUITE A
Mailing Address - City:VERO BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32963-1400
Mailing Address - Country:US
Mailing Address - Phone:772-234-3700
Mailing Address - Fax:772-234-3770
Practice Address - Street 1:5070 HIGHWAY A1A
Practice Address - Street 2:SUITE A
Practice Address - City:VERO BEACH
Practice Address - State:FL
Practice Address - Zip Code:32963-1400
Practice Address - Country:US
Practice Address - Phone:772-234-3700
Practice Address - Fax:772-234-3770
Is Sole Proprietor?:No
Enumeration Date:2006-11-08
Last Update Date:2013-07-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPA 9106413363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
TNS56352Medicare UPIN
TN3667483Medicare ID - Type Unspecified