Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LP0200X | Nurse Practitioner - Pediatrics | APN407 | SC |
NPI | 1013981612 |
---|---|
Provider Name | Theressa L Garris |
First Address | Florence, SC 29502-3239 |
Second Address | Florence, SC 29506-2604 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 13/02/2006 |
Last Update Date | 03/02/2021 |