Provider Demographics
NPI:1417395351
Name:GARRETT, ELIZABETH AMANDA (PA-C)
Entity Type:Individual
Prefix:
First Name:ELIZABETH
Middle Name:AMANDA
Last Name:GARRETT
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:19200 PRESTON RD STE 120
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75252-2450
Mailing Address - Country:US
Mailing Address - Phone:469-200-2832
Mailing Address - Fax:469-269-1074
Practice Address - Street 1:19200 PRESTON RD STE 120
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75252-2450
Practice Address - Country:US
Practice Address - Phone:469-200-2832
Practice Address - Fax:469-269-1074
Is Sole Proprietor?:No
Enumeration Date:2013-06-13
Last Update Date:2020-05-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LAPA.200620363A00000X
TXPA09843363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant