MEDICARE: GRACIN SAPP FNP-C

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	363LF0000X	Family Nurse Practitioner	RN278699	GA

General Provider Information

NPI Number	:	1508608308
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	GRACIN SAPP FNP-C

Provider Business Mailing Address
First Line	:	2591 US HIGHWAY 17
Second Line	:
City	:	RICHMOND HILL
State	:	GA
Zip	:	31324-3864
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	2591 US HIGHWAY 17
Second Line	:
City	:	RICHMOND HILL
State	:	GA
Zip	:	31324-3864
Country	:	US
Telephone Number	:	912-459-7546
Fax Number	:

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

Provider Enumeration Date	:	06/11/2024
Last Update Date	:	06/11/2024

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Directions to “ GRACIN SAPP FNP-C” Practice Location

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