Provider Demographics
NPI:1073115184
Name:GARMIZO, ARIELLA JEANINE
Entity Type:Individual
Prefix:
First Name:ARIELLA
Middle Name:JEANINE
Last Name:GARMIZO
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:404 SW SANDY WAY
Mailing Address - Street 2:
Mailing Address - City:PORT ST LUCIE
Mailing Address - State:FL
Mailing Address - Zip Code:34986-2084
Mailing Address - Country:US
Mailing Address - Phone:954-803-1156
Mailing Address - Fax:
Practice Address - Street 1:8980 S US HIGHWAY 1 STE 103
Practice Address - Street 2:
Practice Address - City:PORT ST LUCIE
Practice Address - State:FL
Practice Address - Zip Code:34952-3482
Practice Address - Country:US
Practice Address - Phone:561-406-9566
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-11-13
Last Update Date:2020-11-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPA9113788363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantGroup - Single Specialty