Provider Demographics
NPI:1205990983
Name:GARRISON, TABITHA T (FNP)
Entity type:Individual
Prefix:
First Name:TABITHA
Middle Name:T
Last Name:GARRISON
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:173 EAST SPRINGBROOK ROAD
Mailing Address - Street 2:
Mailing Address - City:BROADWAY
Mailing Address - State:VA
Mailing Address - Zip Code:22815
Mailing Address - Country:US
Mailing Address - Phone:540-901-7028
Mailing Address - Fax:540-901-2599
Practice Address - Street 1:173 EAST SPRINGBROOK ROAD
Practice Address - Street 2:
Practice Address - City:BROADWAY
Practice Address - State:VA
Practice Address - Zip Code:22815
Practice Address - Country:US
Practice Address - Phone:540-901-7028
Practice Address - Fax:540-901-2599
Is Sole Proprietor?:No
Enumeration Date:2006-12-20
Last Update Date:2021-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0024167218207QH0002X, 363LF0000X, 208VP0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208VP0000XAllopathic & Osteopathic PhysiciansPain MedicinePain Medicine
No207QH0002XAllopathic & Osteopathic PhysiciansFamily MedicineHospice and Palliative Medicine
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily