Provider Demographics
NPI:1467414888
Name:GARRETT, AMY LOHRKE (MD)
Entity Type:Individual
Prefix:
First Name:AMY
Middle Name:LOHRKE
Last Name:GARRETT
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4611 US HIGHWAY 17
Mailing Address - Street 2:SUITE 2
Mailing Address - City:ORANGE PARK
Mailing Address - State:FL
Mailing Address - Zip Code:32003-8245
Mailing Address - Country:US
Mailing Address - Phone:904-264-4333
Mailing Address - Fax:904-264-4301
Practice Address - Street 1:4611 US HIGHWAY 17
Practice Address - Street 2:SUITE 2
Practice Address - City:ORANGE PARK
Practice Address - State:FL
Practice Address - Zip Code:32003-8245
Practice Address - Country:US
Practice Address - Phone:904-264-4333
Practice Address - Fax:904-264-4301
Is Sole Proprietor?:No
Enumeration Date:2006-04-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME0069769208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL31329OtherBLUE CROSS/BLUE SHIELD
H79404Medicare UPIN