Provider Demographics
NPI:1538856687
Name:GARSIDE, ELIZA MARIE
Entity type:Individual
Prefix:
First Name:ELIZA
Middle Name:MARIE
Last Name:GARSIDE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:ELIZA
Other - Middle Name:MARIE
Other - Last Name:PRATT
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:8869 S SUTTON WAY
Mailing Address - Street 2:
Mailing Address - City:SALT LAKE CITY
Mailing Address - State:UT
Mailing Address - Zip Code:84121-6148
Mailing Address - Country:US
Mailing Address - Phone:541-971-0530
Mailing Address - Fax:
Practice Address - Street 1:1840 S 1300 E
Practice Address - Street 2:
Practice Address - City:SALT LAKE CITY
Practice Address - State:UT
Practice Address - Zip Code:84105-3697
Practice Address - Country:US
Practice Address - Phone:801-832-2200
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-04-19
Last Update Date:2024-12-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT11930066-4405363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily