Provider Demographics
NPI:1831515717
Name:GARRETT-HARVEY, JACQUETTA (RPA-C)
Entity type:Individual
Prefix:
First Name:JACQUETTA
Middle Name:
Last Name:GARRETT-HARVEY
Suffix:
Gender:F
Credentials:RPA-C
Other - Prefix:
Other - First Name:JACQUETTA
Other - Middle Name:G
Other - Last Name:HARVEY
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:42 BRENTWOOD RD
Mailing Address - Street 2:
Mailing Address - City:BAY SHORE
Mailing Address - State:NY
Mailing Address - Zip Code:11706-6924
Mailing Address - Country:US
Mailing Address - Phone:631-665-6551
Mailing Address - Fax:631-665-9555
Practice Address - Street 1:42 BRENTWOOD RD
Practice Address - Street 2:
Practice Address - City:BAY SHORE
Practice Address - State:NY
Practice Address - Zip Code:11706-6924
Practice Address - Country:US
Practice Address - Phone:631-665-6551
Practice Address - Fax:631-665-9555
Is Sole Proprietor?:No
Enumeration Date:2014-03-14
Last Update Date:2014-03-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY003780363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant