Provider Demographics
NPI:1619566817
Name:GARASZ, KELLY ANN (RN)
Entity Type:Individual
Prefix:
First Name:KELLY
Middle Name:ANN
Last Name:GARASZ
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2180 NE 67TH ST
Mailing Address - Street 2:
Mailing Address - City:FORT LAUDERDALE
Mailing Address - State:FL
Mailing Address - Zip Code:33308-1160
Mailing Address - Country:US
Mailing Address - Phone:716-341-9650
Mailing Address - Fax:
Practice Address - Street 1:2180 NE 67TH ST
Practice Address - Street 2:
Practice Address - City:FORT LAUDERDALE
Practice Address - State:FL
Practice Address - Zip Code:33308-1160
Practice Address - Country:US
Practice Address - Phone:716-341-9650
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-01-12
Last Update Date:2021-01-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY619834163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse