Provider Demographics
NPI:1164562948
Name:GARNICA, MARY ANN (APRN)
Entity Type:Individual
Prefix:MRS
First Name:MARY
Middle Name:ANN
Last Name:GARNICA
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:22 OUACHITA DR
Mailing Address - Street 2:
Mailing Address - City:MAUMELLE
Mailing Address - State:AR
Mailing Address - Zip Code:72113-6374
Mailing Address - Country:US
Mailing Address - Phone:918-978-9555
Mailing Address - Fax:
Practice Address - Street 1:22 OUACHITA DR
Practice Address - Street 2:
Practice Address - City:MAUMELLE
Practice Address - State:AR
Practice Address - Zip Code:72113-6374
Practice Address - Country:US
Practice Address - Phone:918-978-9555
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-02-08
Last Update Date:2016-02-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARA03248363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily