=====================================================
General NPI Number Information
=====================================================
NPI Number | 1295650521
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | ERIC DONALD GRACE FNP-BC
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 08/13/2026
-----------------------------------------------------
Last Update Date | 09/01/2026
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1725 SE 28TH LOOP
-----------------------------------------------------
City | OCALA
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 34471-5323
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 352-629-1743
-----------------------------------------------------
Fax | 352-629-1748
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 4671 SW 114TH ST
-----------------------------------------------------
City | OCALA
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 34476-4302
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 352-817-5700
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 363L00000X
-----------------------------------------------------
Taxonomy Name | Nurse Practitioner
-----------------------------------------------------
License Number | 961937
-----------------------------------------------------
License Number State | FL
-----------------------------------------------------