Provider Demographics
NPI:1245768852
Name:GARRETT, TRAVICIA LACOLE (RN, FNP-C)
Entity type:Individual
Prefix:
First Name:TRAVICIA
Middle Name:LACOLE
Last Name:GARRETT
Suffix:
Gender:F
Credentials:RN, FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Mailing Address - Street 1:633 W DAVIS ST STE 1032
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75208-4745
Mailing Address - Country:US
Mailing Address - Phone:214-966-3070
Mailing Address - Fax:
Practice Address - Street 1:315 S COCKRELL HILL RD STE 200
Practice Address - Street 2:
Practice Address - City:DUNCANVILLE
Practice Address - State:TX
Practice Address - Zip Code:75116-4099
Practice Address - Country:US
Practice Address - Phone:972-572-2121
Practice Address - Fax:214-580-5180
Is Sole Proprietor?:No
Enumeration Date:2017-05-25
Last Update Date:2018-09-11
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
TXAP134048363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily