Healthcare Provider Details

I. General information

NPI: 1598304230
Provider Name (Legal Business Name): JOSHUA GRISCTI
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/28/2019
Last Update Date: 03/24/2020
Certification Date: 03/24/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2083 RIVER REACH DR APT 457
NAPLES FL
34104-6957
US

IV. Provider business mailing address

2083 RIVER REACH DR APT 457
NAPLES FL
34104-6957
US

V. Phone/Fax

Practice location:
  • Phone: 516-784-6666
  • Fax:
Mailing address:
  • Phone: 516-784-6666
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number9462758
License Number StateFL
# 2
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number11006649
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: