Provider Demographics
NPI:1932685781
Name:GARROW, JALISA MARIE (NP)
Entity Type:Individual
Prefix:
First Name:JALISA
Middle Name:MARIE
Last Name:GARROW
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:JALISA
Other - Middle Name:MARIE
Other - Last Name:THOMAS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:25500 POINT LOOKOUT RD
Mailing Address - Street 2:
Mailing Address - City:LEONARDTOWN
Mailing Address - State:MD
Mailing Address - Zip Code:20650-2015
Mailing Address - Country:US
Mailing Address - Phone:301-475-8981
Mailing Address - Fax:
Practice Address - Street 1:25500 POINT LOOKOUT RD
Practice Address - Street 2:
Practice Address - City:LEONARDTOWN
Practice Address - State:MD
Practice Address - Zip Code:20650-2015
Practice Address - Country:US
Practice Address - Phone:301-475-8981
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-07-16
Last Update Date:2018-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDR209736363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner