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General NPI Number Information
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NPI Number | 1922215128
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Entity Type | Individual
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Provider Name | VICKY NELL GROCE CFNP
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Gender | Female
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Dates
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Enumeration Date | 05/17/2007
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 212 SOUTH PUBLIC SQUARE
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City | PETERSBURG
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State | TN
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Zip | 37144-0093
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Country | US
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Telephone | 931-659-6337
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Fax |
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Provider Business Mailing Address
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Address Line | 1005 COVEMONT DR
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City | FAYETTEVILLE
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State | TN
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Zip | 37334-2284
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Country | US
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Telephone | 931-438-0687
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Fax | 931-438-7456
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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 | APN0000005895
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License Number State | TN
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