Provider Demographics
NPI:1013505189
Name:GARG, NISHTHA (PHYSICIAN ASSISTANT)
Entity Type:Individual
Prefix:
First Name:NISHTHA
Middle Name:
Last Name:GARG
Suffix:
Gender:F
Credentials:PHYSICIAN ASSISTANT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7857 BLACKSTONE RIVER DR E
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32256-2993
Mailing Address - Country:US
Mailing Address - Phone:904-305-3480
Mailing Address - Fax:
Practice Address - Street 1:5535 S WILLIAMSON BLVD # 722
Practice Address - Street 2:
Practice Address - City:PORT ORANGE
Practice Address - State:FL
Practice Address - Zip Code:32128-8311
Practice Address - Country:US
Practice Address - Phone:386-231-6325
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-01-05
Last Update Date:2022-12-21
Deactivation Date:
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Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant