Healthcare Provider Details

I. General information

NPI: 1891453866
Provider Name (Legal Business Name): GRANT MICHAEL NEELEY
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/07/2021
Last Update Date: 05/12/2026
Certification Date: 05/12/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5367 SPRING HILL DR
SPRING HILL FL
34606-4540
US

IV. Provider business mailing address

4863 PALM COAST PKWY NW UNIT 2
PALM COAST FL
32137-3665
US

V. Phone/Fax

Practice location:
  • Phone: 386-222-7746
  • Fax: 386-310-2381
Mailing address:
  • Phone: 386-222-7746
  • Fax: 386-310-2381

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAPRN406225
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: