Provider Demographics
NPI:1598138091
Name:GARLITZ, SHELLY KIMBERLY (FNP)
Entity Type:Individual
Prefix:
First Name:SHELLY
Middle Name:KIMBERLY
Last Name:GARLITZ
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1185 SHERIDAN DR
Mailing Address - Street 2:
Mailing Address - City:ALPENA
Mailing Address - State:MI
Mailing Address - Zip Code:49707-7804
Mailing Address - Country:US
Mailing Address - Phone:989-792-4090
Mailing Address - Fax:989-792-4094
Practice Address - Street 1:4450 FASHION SQUARE BLVD
Practice Address - Street 2:
Practice Address - City:SAGINAW
Practice Address - State:MI
Practice Address - Zip Code:48603-1251
Practice Address - Country:US
Practice Address - Phone:989-792-4090
Practice Address - Fax:989-792-4094
Is Sole Proprietor?:No
Enumeration Date:2015-11-05
Last Update Date:2015-11-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4704272527363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily