Provider Demographics
NPI:1174370910
Name:GARRIS, MARY JANE (APRN, FNP-C)
Entity type:Individual
Prefix:
First Name:MARY
Middle Name:JANE
Last Name:GARRIS
Suffix:
Gender:F
Credentials: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 1:340 E PENIEL RD
Mailing Address - Street 2:
Mailing Address - City:PALATKA
Mailing Address - State:FL
Mailing Address - Zip Code:32177-8434
Mailing Address - Country:US
Mailing Address - Phone:386-937-9611
Mailing Address - Fax:386-385-3915
Practice Address - Street 1:340 E PENIEL RD
Practice Address - Street 2:
Practice Address - City:PALATKA
Practice Address - State:FL
Practice Address - Zip Code:32177-8434
Practice Address - Country:US
Practice Address - Phone:386-937-9611
Practice Address - Fax:386-385-3915
Is Sole Proprietor?:Yes
Enumeration Date:2024-04-30
Last Update Date:2024-04-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAPRN11030654207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine