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General NPI Number Information
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NPI Number | 1255051033
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Entity Type | Individual
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Provider Name | GRACE NICOLE THAYER APRN
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Gender | Female
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Dates
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Enumeration Date | 08/31/2022
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Last Update Date | 03/22/2023
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Provider Practice Location Address
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Address Line | 92 N DEAN RD STE 100
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City | ORLANDO
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State | FL
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Zip | 32825-3769
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Country | US
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Telephone | 407-916-0304
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Fax |
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Provider Business Mailing Address
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Address Line | 845 E CHARING CROSS CIR
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City | LAKE MARY
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State | FL
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Zip | 32746-3774
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Country | US
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Telephone |
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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 | 11021558
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License Number State | FL
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Taxonomy #2
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Taxonomy Code | 363L00000X
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Taxonomy Name | Nurse Practitioner
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License Number | 11021558
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License Number State | FL
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