Provider Demographics
NPI:1477042406
Name:GARRETT, TRICIA E (MS)
Entity type:Individual
Prefix:
First Name:TRICIA
Middle Name:E
Last Name:GARRETT
Suffix:
Gender:
Credentials:MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:19 PRESERVATION DR
Mailing Address - Street 2:
Mailing Address - City:FALMOUTH
Mailing Address - State:ME
Mailing Address - Zip Code:04105-1769
Mailing Address - Country:US
Mailing Address - Phone:765-610-8634
Mailing Address - Fax:207-544-5157
Practice Address - Street 1:4 UNION PARK RD # 8
Practice Address - Street 2:
Practice Address - City:TOPSHAM
Practice Address - State:ME
Practice Address - Zip Code:04086-1711
Practice Address - Country:US
Practice Address - Phone:207-200-5907
Practice Address - Fax:207-544-5157
Is Sole Proprietor?:No
Enumeration Date:2018-05-04
Last Update Date:2025-04-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ME363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
ME363A00000XMedicaid