Provider Demographics
NPI:1619902749
Name:GARRETT, TINA S (PA)
Entity Type:Individual
Prefix:
First Name:TINA
Middle Name:S
Last Name:GARRETT
Suffix:
Gender:F
Credentials:PA
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Mailing Address - Street 1:324W WENDOVER AVE 200
Mailing Address - Street 2:
Mailing Address - City:GREENSBORO
Mailing Address - State:NC
Mailing Address - Zip Code:27408-8438
Mailing Address - Country:US
Mailing Address - Phone:336-274-3515
Mailing Address - Fax:336-275-0812
Practice Address - Street 1:1002 N CHURCH ST STE 201
Practice Address - Street 2:
Practice Address - City:GREENSBORO
Practice Address - State:NC
Practice Address - Zip Code:27401-1448
Practice Address - Country:US
Practice Address - Phone:336-336-3780
Practice Address - Fax:336-273-9060
Is Sole Proprietor?:No
Enumeration Date:2006-07-11
Last Update Date:2021-04-22
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
NC103372363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
Q61038Medicare UPIN
NC2765125Medicare PIN