Provider Demographics
NPI:1578676417
Name:PHILLIPS GARRISON, SABRINA (PA)
Entity Type:Individual
Prefix:MS
First Name:SABRINA
Middle Name:
Last Name:PHILLIPS GARRISON
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:P O BOX 2660
Mailing Address - Street 2:
Mailing Address - City:BAY CITY
Mailing Address - State:TX
Mailing Address - Zip Code:77404-2660
Mailing Address - Country:US
Mailing Address - Phone:979-245-2421
Mailing Address - Fax:979-245-6263
Practice Address - Street 1:513 S COLUMBIA DR
Practice Address - Street 2:
Practice Address - City:WEST COLUMBIA
Practice Address - State:TX
Practice Address - Zip Code:77486-3025
Practice Address - Country:US
Practice Address - Phone:979-345-6522
Practice Address - Fax:979-345-4922
Is Sole Proprietor?:No
Enumeration Date:2006-08-16
Last Update Date:2014-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXPA01193363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXP00477539OtherRAILROAD MEDICARE
TX80N349Medicare PIN