Provider Demographics
NPI:1023617420
Name:GARRETT, JOHN BERTRAM IV (MSN, APRN, FNP-C)
Entity type:Individual
Prefix:MR
First Name:JOHN
Middle Name:BERTRAM
Last Name:GARRETT
Suffix:IV
Gender:M
Credentials:MSN, APRN, FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5079 GARRETT RD
Mailing Address - Street 2:
Mailing Address - City:MALONE
Mailing Address - State:FL
Mailing Address - Zip Code:32445-3409
Mailing Address - Country:US
Mailing Address - Phone:850-557-3761
Mailing Address - Fax:
Practice Address - Street 1:5079 GARRETT RD
Practice Address - Street 2:
Practice Address - City:MALONE
Practice Address - State:FL
Practice Address - Zip Code:32445-3409
Practice Address - Country:US
Practice Address - Phone:505-557-3761
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-10-19
Last Update Date:2020-10-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAPRN11008985363LP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP2300XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPrimary Care