Provider Demographics
NPI:1548987704
Name:GARRETT, JENNA ROBERTS (NURSE PRACTITIONER)
Entity type:Individual
Prefix:
First Name:JENNA
Middle Name:ROBERTS
Last Name:GARRETT
Suffix:
Gender:F
Credentials:NURSE PRACTITIONER
Other - Prefix:
Other - First Name:JENNA
Other - Middle Name:MARIE
Other - Last Name:ROBERTS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:253 W DOUBLEGATE DR
Mailing Address - Street 2:
Mailing Address - City:ALBANY
Mailing Address - State:GA
Mailing Address - Zip Code:31721-6305
Mailing Address - Country:US
Mailing Address - Phone:229-869-3366
Mailing Address - Fax:
Practice Address - Street 1:259 US HIGHWAY 19 N
Practice Address - Street 2:
Practice Address - City:CAMILLA
Practice Address - State:GA
Practice Address - Zip Code:31730-1410
Practice Address - Country:US
Practice Address - Phone:229-336-1949
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-10-27
Last Update Date:2023-12-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN268798363LP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP2300XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPrimary Care