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General NPI Number Information
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NPI Number | 1841927100
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Entity Type | Individual
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Provider Name | MR. AUSTIN GROVES
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Gender | Male
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Dates
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Enumeration Date | 08/05/2022
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Last Update Date | 08/08/2022
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Provider Practice Location Address
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Address Line | 10111 BEDFORD LAKES CT
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City | JACKSONVILLE
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State | FL
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Zip | 32222-4119
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Country | US
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Telephone | 352-235-0395
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Fax |
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Provider Business Mailing Address
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Address Line | 10111 BEDFORD LAKES CT
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City | JACKSONVILLE
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State | FL
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Zip | 32222-4119
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Country | US
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Telephone | 352-235-0395
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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 | RN9390729
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License Number State | FL
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Taxonomy #2
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | 11021267
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License Number State | FL
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