Healthcare Provider Details

I. General information

NPI: 1295650521
Provider Name (Legal Business Name): ERIC DONALD GRACE FNP-BC
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/13/2026
Last Update Date: 09/01/2026
Certification Date: 09/01/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1725 SE 28TH LOOP
OCALA FL
34471-5323
US

IV. Provider business mailing address

4671 SW 114TH ST
OCALA FL
34476-4302
US

V. Phone/Fax

Practice location:
  • Phone: 352-629-1743
  • Fax: 352-629-1748
Mailing address:
  • Phone: 352-817-5700
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number961937
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: