Healthcare Provider Details

I. General information

NPI: 1881520377
Provider Name (Legal Business Name): GRACE MCGINN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/22/2026
Last Update Date: 06/22/2026
Certification Date: 06/22/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9320 STATE ROAD 54
TRINITY FL
34655-1808
US

IV. Provider business mailing address

2890 CENTER POINTE DR
FORT MYERS FL
33916-9521
US

V. Phone/Fax

Practice location:
  • Phone: 727-842-8411
  • Fax:
Mailing address:
  • Phone: 239-274-8200
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP2300X
TaxonomyPrimary Care Nurse Practitioner
License Number11048679
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: