Healthcare Provider Details

I. General information

NPI: 1316043805
Provider Name (Legal Business Name): JOANNE PATRICIA GRANTEED NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/15/2006
Last Update Date: 03/28/2021
Certification Date: 03/28/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3501 JOHNSON ST
HOLLYWOOD FL
33021-5421
US

IV. Provider business mailing address

PO BOX 534257
ATLANTA GA
30353-4257
US

V. Phone/Fax

Practice location:
  • Phone: 354-663-1455
  • Fax:
Mailing address:
  • Phone: 305-651-2270
  • Fax: 904-346-0113

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number1520782
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: