Provider Demographics
NPI:1437884640
Name:GARRISON, VANESSA CHANEL (APRN)
Entity Type:Individual
Prefix:
First Name:VANESSA
Middle Name:CHANEL
Last Name:GARRISON
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:VANESSA
Other - Middle Name:CHANEL
Other - Last Name:PEDERSEN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:708 W IDLEWILD AVE
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33604-6536
Mailing Address - Country:US
Mailing Address - Phone:904-704-1480
Mailing Address - Fax:
Practice Address - Street 1:2502 W SAINT ISABEL ST
Practice Address - Street 2:
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33607-6318
Practice Address - Country:US
Practice Address - Phone:813-874-5707
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-07-21
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL11020556363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner