Provider Demographics
NPI:1174024731
Name:T. GARRETT FAMILY HEALTH AND WELLNESS CLINIC
Entity Type:Organization
Organization Name:T. GARRETT FAMILY HEALTH AND WELLNESS CLINIC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/ NURSE PRACTITIONER
Authorized Official - Prefix:
Authorized Official - First Name:TRAVICIA
Authorized Official - Middle Name:LACOLE
Authorized Official - Last Name:GARRETT
Authorized Official - Suffix:
Authorized Official - Credentials:FNP-C
Authorized Official - Phone:214-966-3070
Mailing Address - Street 1:633 W DAVIS ST STE 1032
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75208-4745
Mailing Address - Country:US
Mailing Address - Phone:972-572-2121
Mailing Address - Fax:214-580-5180
Practice Address - Street 1:315 S COCKRELL HILL RD STE 200
Practice Address - Street 2:
Practice Address - City:DUNCANVILLE
Practice Address - State:TX
Practice Address - Zip Code:75116
Practice Address - Country:US
Practice Address - Phone:972-572-2121
Practice Address - Fax:214-580-5180
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-02-27
Last Update Date:2018-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary CareGroup - Multi-Specialty
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Multi-Specialty