GRACE PEDIATRICS PL (NPI# 1720362429) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1720362429 |
| Entity Type | Organization |
| Organization Name | GRACE PEDIATRICS PL |
| Practice Address |
4196 W Us Highway 90 Suite 105 Lake City FL 32055-8834 |
| Practice Telephone | 3862438474 |
| Practice Fax Number | 3864385945 |
| Mailing Telephone | 3862438474 |
| Mailing Fax Number | 3864385945 |
| Enumeration Date | 2011-09-29 |
| Last Update Date | 2014-02-19 |
| Authorized Official Name | COLLEEN THOMPSON (MANAGER/ARNP/CO-OWNER) |
| Authorized Official Telephone | 3862438474 |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| N | 363LP0200X |
Nurse Practitioner Specialization: Pediatrics |
9220069 | FL | Physician Assistants & Advanced Practice Nursing Providers |
| Y | 363LP0200X |
Nurse Practitioner Specialization: Pediatrics |
2667852 | FL | Physician Assistants & Advanced Practice Nursing Providers |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| FL | MEDICARE RHC CERTIFICATION | 68-3810 | 01 |
| FL | 004797600 | 05 |
| Street Address |
4196 W US HIGHWAY 90 SUITE 105 |
| City | LAKE CITY |
| State | FL |
| Zip Code | 32055-8834 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1922007475 | Colleen A Thompson | Nurse Practitioner | 4196 W Us Highway 90, Ste 105, Lake City, FL 32055-8833 | 2005-07-18 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1114439510 | Melissa Fay Peters | Nurse Practitioner | 5085 West Us Highway 90, Lake City, FL 32055 | 2017-10-26 |
| 1851801765 | Stephanie Jo Nogle | Occupational Therapist | Brooks Americare: 4251 Nw American Ln, #103, Lake City, FL 32055 | 2017-10-05 |
| 1831617273 | Erica Mayo | Pharmacist | 4846 Nw Lake Jeffery Rd., Lake City, FL 32055 | 2017-09-06 |
| 1144759333 | Jerry Hamilton Cheesman | Dentist | 217 Ne Franklin Sreet, Lake City, FL 32055 | 2017-06-09 |
| 1487183745 | Joshua Allore | Dentist | 2970 W Us Highway 90., Lake City, FL 32055 | 2017-06-08 |
| 1497298418 | Careing Hands | Preferred Provider Organization | 1471nw Queen Rd, Lakecity, FL 32055 | 2016-11-22 |
| 1881148278 | Corniqueca Stewart-simmons | Nurse Practitioner | 340 Nw Commerce Drive, Lake City, FL 32055 | 2016-08-15 |
| 1164809141 | Latasha Harten-jones | Licensed Practical Nurse | 443 Ne Sims Dr, Lake City, FL 32055 | 2015-04-29 |
| 1154716447 | Lindsey Morton | Counselor | 219 Se Baya Avenue, Lake City, FL 32055 | 2015-04-02 |
| 1124439351 | Tynette Jordan | Counselor | 708 N.w Wilson St., Lake City, FL 32055 | 2014-05-09 |
| Find all providers in zip 32055 | ||||
| Taxonomy Code | 363LP0200X |
| Grouping | Physician Assistants & Advanced Practice Nursing Providers |
| Classification | Nurse Practitioner |
| Specialization | Pediatrics |
| Definition to come... |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1710966346 | Jessica Shotwell | Nurse Practitioner | 4196 W Us Highway 90 Ste 105, Lake City, FL 32055-8834 | 2006-01-12 |
| 1639736580 | Jamilyn Vaughn Jordan | Nurse Practitioner | 1140 Sw Bascom Norris Dr Ste 104, Lake City, FL 32025-1329 | 2019-05-28 |
| 1912462466 | April Lawson | Nurse Practitioner | 4196 W Us Highway 90 Ste 105, Lake City, FL 32055-8834 | 2019-02-08 |
| 1053829549 | Samantha Lawrence | Nurse Practitioner | 1140 Sw Bascom Norris Dr Ste 104, Lake City, FL 32025-1329 | 2018-01-18 |
| 1801279179 | Megan Tenney | Nurse Practitioner | 1859 Sw Newland Way, Lake City, FL 32025-6966 | 2015-07-06 |
| 1386917524 | Casey Marie Perry | Nurse Practitioner | 1859 Sw Newland Way, Lake City, FL 32025-6966 | 2012-02-20 |
| 1952430670 | Megan Fultz Smith | Nurse Practitioner | 1859 Sw Newland Way, Lake City, FL 32025-6966 | 2007-03-06 |
| 1083680516 | Geraldine S Pallija | Nurse Practitioner | 1859 Sw Newland Way, Lake City, FL 32025-6966 | 2006-02-24 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1003417072 | Carmen Moreno | Nurse Practitioner | 336 Golfview Rd Apt 909, North Palm Beach, FL 33408-3512 | 2020-11-05 |
| 1366043614 | Christi Koshy | Nurse Practitioner | 4025 N Nob Hill Rd Apt 207, Sunrise, FL 33351-5811 | 2020-11-03 |
| 1730789322 | Michelle Yen-vera | Nurse Practitioner | 18409 Nw 9th Ct, Pembroke Pines, FL 33029-3607 | 2020-11-01 |
| 1376143487 | Aimee N Jorgenson Stough | Nurse Practitioner | 91550 Overseas Hwy Ste 209, Tavernier, FL 33070-2513 | 2020-10-28 |
| 1588271233 | Olivia Janelle De Jong | Nurse Practitioner | 424 Ne 6th St Apt D, Gainesville, FL 32601-5576 | 2020-09-28 |
| 1801407796 | Elisabeth Morley Chinlund | Nurse Practitioner | 445 Delmar Ter S Apt 5, Saint Petersburg, FL 33701-4653 | 2020-08-13 |
| 1972113025 | Nicole Horn | Nurse Practitioner | 8095 Spyglass Hill Rd Ste 104, Melbourne, FL 32940-8290 | 2020-08-04 |
| 1073131850 | Olivia Dawn Wilson | Nurse Practitioner | 5105 Clover Mist Dr, Apollo Beach, FL 33572-3417 | 2020-07-08 |
| 1427687565 | Cortney M Starr | Nurse Practitioner | 2261 Kingfisher Ln, Clearwater, FL 33762-3323 | 2020-04-01 |
| 1285263335 | Summer Leigh Moran | Nurse Practitioner | 528 W Baldwin Rd # A, Panama City, FL 32405-3313 | 2020-04-01 |
| Find all providers with the same taxonomy | ||||
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.