MEDICARE: EDUWARD XAVIER GRANDES APRN

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
1	363LP0808X	Psychiatric/Mental Health Nurse Practitioner	83525	NM
2	363LP0808X	Psychiatric/Mental Health Nurse Practitioner	11037062	FL
3	363LP0808X	Psychiatric/Mental Health Nurse Practitioner	406990	NY

General Provider Information

NPI Number	:	1932919321
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	EDUWARD XAVIER GRANDES APRN

Provider Business Mailing Address
First Line	:	2151 W HILLSBORO BLVD STE 211
Second Line	:
City	:	DEERFIELD BEACH
State	:	FL
Zip	:	33442-1275
Country	:	US
Telephone Number	:	954-694-7292
Fax Number	:	949-864-3367

Provider Business Practice Location Address
First Line	:	2151 W HILLSBORO BLVD STE 211
Second Line	:
City	:	DEERFIELD BEACH
State	:	FL
Zip	:	33442-1275
Country	:	US
Telephone Number	:	954-694-7292
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/09/2025
Last Update Date	:	02/19/2026

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