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NPI Code Detail

MEDICARE: NICOLE GRENNAN

MEDICARE:   NICOLE  GRENNAN
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
1225100000XPhysical TherapistPT 28788FL

General Provider Information

NPI Number : 1568886513
Entity Type Code : Individual
Provider Name (Legal Business Name) : NICOLE GRENNAN
Provider Business Mailing Address
First Line : 3901 UNIVERSITY BLVD S
Second Line :
City : JACKSONVILLE
State : FL
Zip : 32216-4312
Country : US
Telephone Number : 904-635-3192
Fax Number :
Provider Business Practice Location Address
First Line : 7749 NORMANDY BLVD STE 147
Second Line :
City : JACKSONVILLE
State : FL
Zip : 32221-7658
Country : US
Telephone Number : 904-786-5576
Fax Number : 904-786-9907
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 02/11/2014
Last Update Date : 02/11/2014

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Directions to “ NICOLE GRENNAN ” Practice Location

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