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General NPI Number Information
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NPI Number | 1447458211
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Entity Type | Individual
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Provider Name | MARIE GRANT BATES ARNP
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Gender | Female
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Dates
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Enumeration Date | 07/03/2007
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 400 HEALTH PARK BLVD
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City | ST AUGUSTINE
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State | FL
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Zip | 32086-5784
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Country | US
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Telephone | 904-819-4598
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Fax | 907-819-5090
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Provider Business Mailing Address
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Address Line | 4544 GOLF RIDGE DR
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City | ELKTON
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State | FL
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Zip | 32033-4010
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Country | US
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Telephone | 904-829-5031
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Fax | 904-829-5031
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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 | ARNP9174644
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License Number State | FL
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