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General NPI Number Information
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NPI Number | 1548744634
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Entity Type | Individual
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Provider Name | ARIEL TAWANDA GRAHAM AGPCNP-C
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Gender | Female
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Dates
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Enumeration Date | 09/24/2018
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Last Update Date | 09/24/2018
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Provider Practice Location Address
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Address Line | 622 SW 52ND ST
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City | CAPE CORAL
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State | FL
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Zip | 33914-6518
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Country | US
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Telephone | 727-212-3249
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Fax |
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Provider Business Mailing Address
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Address Line | 4480 46TH AVE N
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City | ST PETERSBURG
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State | FL
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Zip | 33714-2904
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Country | US
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Telephone | 727-212-3249
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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 | 363LG0600X
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Taxonomy Name | Gerontology Nurse Practitioner
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License Number | 9367877
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License Number State | FL
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Taxonomy #2
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Taxonomy Code | 363LA2200X
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Taxonomy Name | Adult Health Nurse Practitioner
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License Number | 9367877
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License Number State | FL
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