Provider Demographics
NPI:1952629776
Name:GARRETT, JENNIFER (PA-C)
Entity Type:Individual
Prefix:MS
First Name:JENNIFER
Middle Name:
Last Name:GARRETT
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8338 ALLEN RD
Mailing Address - Street 2:SUITE 101
Mailing Address - City:ALLEN PARK
Mailing Address - State:MI
Mailing Address - Zip Code:48101-1402
Mailing Address - Country:US
Mailing Address - Phone:313-386-5500
Mailing Address - Fax:313-386-1339
Practice Address - Street 1:8338 ALLEN RD
Practice Address - Street 2:SUITE 101
Practice Address - City:ALLEN PARK
Practice Address - State:MI
Practice Address - Zip Code:48101-1402
Practice Address - Country:US
Practice Address - Phone:313-386-5500
Practice Address - Fax:313-386-1339
Is Sole Proprietor?:No
Enumeration Date:2010-05-05
Last Update Date:2014-08-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5601003139207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine