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General NPI Number Information
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NPI Number | 1144818709
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Entity Type | Individual
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Provider Name | JAMES EDWARD GRAVES III FNP-C
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Gender | Male
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Dates
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Enumeration Date | 01/08/2021
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Last Update Date | 08/05/2022
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Provider Practice Location Address
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Address Line | 1032 MAR WALT DR UNIT 250
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City | FORT WALTON BEACH
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State | FL
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Zip | 32547-6663
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Country | US
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Telephone | 850-224-4345
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Fax |
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Provider Business Mailing Address
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Address Line | 15 TALL PINE TRL
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City | SHALIMAR
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State | FL
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Zip | 32579-1915
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Country | US
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Telephone | 251-550-2055
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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 | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | 11010974
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License Number State | FL
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