Healthcare Provider Details

I. General information

NPI: 1598146581
Provider Name (Legal Business Name): LAUREN MARIE GRAVOIS NP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/15/2015
Last Update Date: 06/27/2025
Certification Date: 06/27/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4797 GRASSENDALE TER
SANFORD FL
32771-0034
US

IV. Provider business mailing address

4797 GRASSENDALE TER
SANFORD FL
32771-0034
US

V. Phone/Fax

Practice location:
  • Phone: 941-586-2004
  • Fax:
Mailing address:
  • Phone: 941-586-2004
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAPRN9355757
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code207RG0100X
TaxonomyGastroenterology Physician
License NumberAPRN9355757
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: