Provider Demographics
NPI:1003293382
Name:OLSEN, GARRICK ANDREW (PA-C)
Entity type:Individual
Prefix:
First Name:GARRICK
Middle Name:ANDREW
Last Name:OLSEN
Suffix:
Gender:M
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 1:3250 N PINAL PKWY
Mailing Address - Street 2:
Mailing Address - City:FLORENCE
Mailing Address - State:AZ
Mailing Address - Zip Code:85132-9459
Mailing Address - Country:US
Mailing Address - Phone:520-868-8443
Mailing Address - Fax:
Practice Address - Street 1:3250 N PINAL PKWY
Practice Address - Street 2:
Practice Address - City:FLORENCE
Practice Address - State:AZ
Practice Address - Zip Code:85132-9459
Practice Address - Country:US
Practice Address - Phone:520-868-8443
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-05-06
Last Update Date:2024-12-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT13095282-1206363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant