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General NPI Number Information
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NPI Number | 1093332090
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Entity Type | Individual
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Provider Name | BRIANNA NICHOLE GRANT
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Gender | Female
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Dates
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Enumeration Date | 06/25/2020
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Last Update Date | 11/15/2023
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Provider Practice Location Address
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Address Line | 210 N TUSTIN AVE
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City | SANTA ANA
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State | CA
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Zip | 92705-3807
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Country | US
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Telephone | 888-959-5912
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Fax |
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Provider Business Mailing Address
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Address Line | 4675 LINTON BLVD STE 102
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City | DELRAY BEACH
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State | FL
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Zip | 33445-6615
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Country | US
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Telephone | 954-839-5923
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number | 1093332090
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License Number State | FL
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