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NPI Code Detail

MEDICARE: MRS. MARY NICOLE GREAVES FNP-C

MEDICARE: MRS. MARY NICOLE GREAVES FNP-C
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1363LF0000XFamily Nurse PractitionerAP133941TX
2363LF0000XFamily Nurse Practitioner351141NY
3363LF0000XFamily Nurse Practitioner5007216NC

General Provider Information

NPI Number : 1306249818
Entity Type Code : Individual
Provider Name (Legal Business Name) : MRS. MARY NICOLE GREAVES FNP-C
Provider Business Mailing Address
First Line : 3301 QUANTUM BLVD
Second Line :
City : BOYNTON BEACH
State : FL
Zip : 33426-8668
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 3301 QUANTUM BLVD
Second Line :
City : BOYNTON BEACH
State : FL
Zip : 33426-8668
Country : US
Telephone Number : 516-663-3511
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 09/29/2014
Last Update Date : 11/17/2025

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