Healthcare Provider Details

I. General information

NPI: 1487564464
Provider Name (Legal Business Name): FAMILY PRACTITIONER SERVICES, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/10/2026
Last Update Date: 09/10/2026
Certification Date: 09/10/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6989 W 36TH AVE UNIT 204
HIALEAH FL
33018-2998
US

IV. Provider business mailing address

6989 W 36TH AVE UNIT 204
HIALEAH FL
33018-2998
US

V. Phone/Fax

Practice location:
  • Phone: 305-512-1220
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251J00000X
TaxonomyNursing Care Agency
License Number
License Number State

VIII. Authorized Official

Name: ELIZABETH GRADAILLE
Title or Position: PRESIDENT
Credential: APRN
Phone: 305-512-1220