Healthcare Provider Details

I. General information

NPI: 1104852508
Provider Name (Legal Business Name): MARGARET MARY GRISSINGER CRNA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/25/2006
Last Update Date: 02/08/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12230 FRANKLIN BROOK LN S
JACKSONVILLE FL
32225-5186
US

IV. Provider business mailing address

12230 FRANKLIN BROOK LN S
JACKSONVILLE FL
32225-5186
US

V. Phone/Fax

Practice location:
  • Phone: 904-472-0484
  • Fax:
Mailing address:
  • Phone: 904-472-0484
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License NumberARNP1615992
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License NumberCRNA000242
License Number StateNV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: