Provider Demographics
NPI:1033693387
Name:GARRICK, TARA BROWN (MSN, APRN, FNP-C)
Entity Type:Individual
Prefix:
First Name:TARA
Middle Name:BROWN
Last Name:GARRICK
Suffix:
Gender:F
Credentials:MSN, APRN, FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1736 OLD YORK RD
Mailing Address - Street 2:
Mailing Address - City:YORK
Mailing Address - State:SC
Mailing Address - Zip Code:29745-9458
Mailing Address - Country:US
Mailing Address - Phone:803-818-6900
Mailing Address - Fax:803-818-6993
Practice Address - Street 1:1736 OLD YORK RD
Practice Address - Street 2:
Practice Address - City:YORK
Practice Address - State:SC
Practice Address - Zip Code:29745-9458
Practice Address - Country:US
Practice Address - Phone:803-818-6900
Practice Address - Fax:803-818-6993
Is Sole Proprietor?:No
Enumeration Date:2018-09-23
Last Update Date:2018-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC22240363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily