Healthcare Provider Details

I. General information

NPI: 1114847233
Provider Name (Legal Business Name): JENNIFER L GRELLE APRN, FNP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/18/2026
Last Update Date: 07/18/2026
Certification Date: 07/18/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

133 FALMOUTH RD STE 2B
MASHPEE MA
02649-2611
US

IV. Provider business mailing address

1 HERITAGE DR
NORTH EASTON MA
02356-2214
US

V. Phone/Fax

Practice location:
  • Phone: 508-301-1971
  • Fax: 508-638-6466
Mailing address:
  • Phone: 954-809-9614
  • Fax: 508-638-6466

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number08-7586-21
License Number StateNH
# 2
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberRN256818
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: