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General NPI Number Information
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NPI Number | 1114139581
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Entity Type | Individual
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Provider Name | MARY ELIZABETH GRANT A.R.N.P.
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Gender | Female
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Dates
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Enumeration Date | 05/05/2007
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Last Update Date | 04/02/2018
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Provider Practice Location Address
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Address Line | 1120 63RD ST S
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City | GULFPORT
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State | FL
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Zip | 33707-3125
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Country | US
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Telephone | 727-347-2914
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Fax | 727-895-7225
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Provider Business Mailing Address
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Address Line | 1120 63RD ST S
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City | GULFPORT
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State | FL
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Zip | 33707-3125
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Country | US
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Telephone | 727-347-2914
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Fax | 727-895-7225
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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 | 163WP0808X
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Taxonomy Name | Psychiatric/Mental Health Registered Nurse
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License Number | ARNP 1572502
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License Number State | FL
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Taxonomy #2
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Taxonomy Code | 363LP0808X
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Taxonomy Name | Psychiatric/Mental Health Nurse Practitioner
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License Number | ARNP 1572502
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License Number State | FL
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Taxonomy #3
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Taxonomy Code | 363LP0808X
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Taxonomy Name | Psychiatric/Mental Health Nurse Practitioner
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License Number | 019367
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License Number State | OH
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