Provider Demographics
NPI:1881732741
Name:GARRETTT, NANCY NINA (PA)
Entity type:Individual
Prefix:MRS
First Name:NANCY
Middle Name:NINA
Last Name:GARRETTT
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3125 KALLIN AVE
Mailing Address - Street 2:
Mailing Address - City:LONG BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:90808-4204
Mailing Address - Country:US
Mailing Address - Phone:213-923-4074
Mailing Address - Fax:
Practice Address - Street 1:2015 W 1ST ST STE K
Practice Address - Street 2:
Practice Address - City:SANTA ANA
Practice Address - State:CA
Practice Address - Zip Code:92703-3516
Practice Address - Country:US
Practice Address - Phone:714-547-7745
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-02
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPA01124363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAGR0063230Medicaid