Provider Demographics
NPI:1063957694
Name:GARRETT, SALLY (PA)
Entity type:Individual
Prefix:
First Name:SALLY
Middle Name:
Last Name:GARRETT
Suffix:
Gender:F
Credentials:PA
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Mailing Address - Street 1:PO BOX 749495
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30374-9495
Mailing Address - Country:US
Mailing Address - Phone:855-963-2100
Mailing Address - Fax:813-321-1296
Practice Address - Street 1:14551 HOPE CENTER LOOP STE 200
Practice Address - Street 2:
Practice Address - City:FORT MYERS
Practice Address - State:FL
Practice Address - Zip Code:33912-4705
Practice Address - Country:US
Practice Address - Phone:239-264-7026
Practice Address - Fax:239-567-3679
Is Sole Proprietor?:No
Enumeration Date:2017-01-06
Last Update Date:2025-05-20
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Provider Licenses
StateLicense IDTaxonomies
FLPA9110087363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant