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General NPI Number Information
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NPI Number | 1962301614
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Entity Type | Organization
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Legal Business Name | GROUNDED MEN'S HEALTH, PLLC
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Dates
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Enumeration Date | 11/02/2026
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Last Update Date | 11/02/2026
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Provider Practice Location Address
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Address Line | 440 MONTICELLO AVE STE 1870
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City | NORFOLK
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State | VA
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Zip | 23510-2673
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Country | US
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Telephone | 757-347-2462
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Fax | 757-209-5601
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Provider Business Mailing Address
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Address Line | 440 MONTICELLO AVE STE 1870
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City | NORFOLK
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State | VA
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Zip | 23510-2673
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Country | US
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Telephone | 757-347-2462
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Fax | 757-209-5601
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Authorized Official
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Title or Position | OWNER
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Name | KEONTE AISHA TUGGLE FISHER
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Credential | FNP-BC
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Telephone | 757-347-2462
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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 |
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License Number State |
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