Healthcare Provider Details

I. General information

NPI: 1427617067
Provider Name (Legal Business Name): HOLLY MARIE GRISALES APRN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: HOLLY MARIE BALIUS

II. Dates (important events)

Enumeration Date: 06/07/2019
Last Update Date: 05/11/2026
Certification Date: 05/11/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

724 NW 43RD ST
GAINESVILLE FL
32607-6110
US

IV. Provider business mailing address

5801 POSTAL RD
CLEVELAND OH
44181-2184
US

V. Phone/Fax

Practice location:
  • Phone: 352-332-7222
  • Fax: 352-332-7330
Mailing address:
  • Phone: 561-300-2410
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAPRN11002180
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: