Healthcare Provider Details

I. General information

NPI: 1154239523
Provider Name (Legal Business Name): GIANNA DE GRACE
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/28/2026
Last Update Date: 08/28/2026
Certification Date: 08/28/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

13801 N DALE MABRY HWY
TAMPA FL
33618-2412
US

IV. Provider business mailing address

13801 N DALE MABRY HWY
TAMPA FL
33618-2412
US

V. Phone/Fax

Practice location:
  • Phone: 813-515-9602
  • Fax:
Mailing address:
  • Phone: 813-515-9602
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberIMH29713
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: