MEDICARE: MRS. LELIA C GRAY ARNP

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363LP0200X	Pediatric Nurse Practitioner	ARNP1984742	FL
2	363L00000X	Nurse Practitioner	ARNP1984742	FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1285982942
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. LELIA C GRAY ARNP

Provider Business Mailing Address
First Line	:	PO BOX 191
Second Line	:
City	:	ROCKLAND
State	:	DE
Zip	:	19732-0191
Country	:	US
Telephone Number	:	302-651-6212
Fax Number	:	302-651-4945

Provider Business Practice Location Address
First Line	:	435 2ND ST NE
Second Line	:
City	:	WINTER HAVEN
State	:	FL
Zip	:	33881-4103
Country	:	US
Telephone Number	:	863-299-4567
Fax Number	:	863-297-9750

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/28/2012
Last Update Date	:	05/26/2015

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