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General NPI Number Information
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NPI Number | 1134882079
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Entity Type | Individual
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Provider Name | TINA GRANT AGACNP-BC
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Gender | Female
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Dates
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Enumeration Date | 10/18/2021
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Last Update Date | 10/19/2022
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Provider Practice Location Address
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Address Line | 1265 S BROADWAY
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City | DENVER
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State | CO
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Zip | 80210-1503
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Country | US
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Telephone | 303-894-0144
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Fax |
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Provider Business Mailing Address
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Address Line | 10187 W 52ND PL UNIT 306
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City | WHEAT RIDGE
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State | CO
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Zip | 80033-6842
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Country | US
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Telephone | 720-837-9110
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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 | 363LA2100X
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Taxonomy Name | Acute Care Nurse Practitioner
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License Number | 996196
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License Number State | CO
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Taxonomy #2
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Taxonomy Code | 363LG0600X
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Taxonomy Name | Gerontology Nurse Practitioner
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License Number | 996196
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License Number State | CO
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