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General NPI Number Information
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NPI Number | 1972268092
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Entity Type | Individual
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Provider Name | TANISHA GRANT PMHNP-C
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Gender | Female
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Dates
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Enumeration Date | 11/03/2021
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Last Update Date | 08/25/2025
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Provider Practice Location Address
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Address Line | 37177 NORTH AVE
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City | DADE CITY
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State | FL
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Zip | 33523
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Country | US
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Telephone | 678-973-8470
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Fax |
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Provider Business Mailing Address
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Address Line | 38345 LAKE AVE
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City | DADE CITY
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State | FL
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Zip | 33525-4414
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Country | US
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Telephone | 352-467-2935
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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 | APRN11041866
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License Number State | FL
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Taxonomy #2
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Taxonomy Code | 163WG0000X
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Taxonomy Name | General Practice Registered Nurse
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License Number | RN9457208
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License Number State | FL
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