Healthcare Provider Details

I. General information

NPI: 1942131503
Provider Name (Legal Business Name): GRACIE MAE HEALTHCARE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/25/2026
Last Update Date: 05/25/2026
Certification Date: 05/24/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2055 E GEORGIA ST
BARTOW FL
33830-6710
US

IV. Provider business mailing address

PO BOX 1664
BARTOW FL
33831-1664
US

V. Phone/Fax

Practice location:
  • Phone: 863-533-0578
  • Fax:
Mailing address:
  • Phone: 863-304-3550
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: REBECCA SKINNER
Title or Position: PRESIDENT
Credential: ARNP
Phone: 863-304-3550