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General NPI Number Information
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NPI Number | 1154691566
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Entity Type | Organization
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Legal Business Name | GRACEVILLE FAMILY MEDICINE INC
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Dates
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Enumeration Date | 01/03/2012
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Last Update Date | 10/14/2016
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Provider Practice Location Address
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Address Line | 5239 BROWN ST
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City | GRACEVILLE
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State | FL
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Zip | 32440-2513
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Country | US
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Telephone | 850-360-4909
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Fax | 850-360-4911
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Provider Business Mailing Address
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Address Line | 5239 BROWN ST
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City | GRACEVILLE
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State | FL
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Zip | 32440-2513
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Country | US
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Telephone | 850-360-4909
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Fax | 850-360-4911
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Authorized Official
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Title or Position | OWNER
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Name | LUCINDA W COLLINS
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Credential | ARNP
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Telephone | 850-360-4909
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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 | 9321958
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License Number State | FL
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