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General NPI Number Information
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NPI Number | 1881295459
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Entity Type | Individual
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Provider Name | MARIETTE ZANDERS GRAY APRN
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Gender | Female
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Dates
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Enumeration Date | 11/02/2020
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Last Update Date | 11/02/2020
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Provider Practice Location Address
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Address Line | 100 N MAIN ST
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City | CHATTAHOOCHEE
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State | FL
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Zip | 32324-1107
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Country | US
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Telephone | 850-663-7383
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Fax |
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Provider Business Mailing Address
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Address Line | 473 ELK CLUB RD
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City | QUINCY
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State | FL
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Zip | 32352-6492
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Country | US
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Telephone | 850-856-9426
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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 | 363LP0808X
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Taxonomy Name | Psychiatric/Mental Health Nurse Practitioner
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License Number | 11009858
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License Number State | FL
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