Provider Demographics
NPI:1063034429
Name:GARRISON, JARED (AGACNP-BC)
Entity Type:Individual
Prefix:
First Name:JARED
Middle Name:
Last Name:GARRISON
Suffix:
Gender:M
Credentials:AGACNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:700 HARBOR EDGE DR APT 102
Mailing Address - Street 2:
Mailing Address - City:MEMPHIS
Mailing Address - State:TN
Mailing Address - Zip Code:38103-5840
Mailing Address - Country:US
Mailing Address - Phone:248-640-9893
Mailing Address - Fax:
Practice Address - Street 1:700 HARBOR EDGE DR APT 102
Practice Address - Street 2:
Practice Address - City:MEMPHIS
Practice Address - State:TN
Practice Address - Zip Code:38103-5840
Practice Address - Country:US
Practice Address - Phone:248-640-9893
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-05-08
Last Update Date:2020-05-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNAPN0000027259363LA2100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care