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General NPI Number Information
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NPI Number | 1215190459
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Entity Type | Organization
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Legal Business Name | RECTAL RELIEF CENTER
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Dates
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Enumeration Date | 07/08/2008
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Last Update Date | 11/04/2011
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Provider Practice Location Address
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Address Line | 13005 SOUTHERN BLVD STE 122 SUITE 122 MEDICAL MALL ONE
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City | LOXAHATCHEE
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State | FL
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Zip | 33470-9231
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Country | US
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Telephone | 561-842-5050
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Fax | 561-793-9989
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Provider Business Mailing Address
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Address Line | 13005 SOUTHERN BLVD STE 122 SUITE 122 MEDICAL MALL ONE
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City | LOXAHATCHEE
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State | FL
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Zip | 33470-9231
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Country | US
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Telephone | 561-842-5050
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Fax | 561-793-9989
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Authorized Official
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Title or Position | PRESIDENT
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Name | MS. SHERI SHANNON GRISSO
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Credential | ARNP
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Telephone | 561-842-5050
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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 | ARNP3357122
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License Number State | FL
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