MEDICARE: MRS. NABUCHI GRACE ANDERSON MHC

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	172V00000X	Community Health Worker
2	171M00000X	Case Manager/Care Coordinator
3	101YM0800X	Mental Health Counselor	IMH 11052	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
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1700134715
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. NABUCHI GRACE ANDERSON MHC

Provider Business Mailing Address
First Line	:	PO BOX 444
Second Line	:
City	:	MASCOTTE
State	:	FL
Zip	:	34753-0444
Country	:	US
Telephone Number	:	352-255-6458
Fax Number	:	352-410-6118

Provider Business Practice Location Address
First Line	:	15508 WILLET CT
Second Line	:
City	:	MASCOTTE
State	:	FL
Zip	:	34753-9102
Country	:	US
Telephone Number	:	352-255-6458
Fax Number	:	352-410-6118

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

Provider Enumeration Date	:	08/22/2012
Last Update Date	:	07/30/2013

Similar Medicare Providers

1992057723 — LIFE CHANGE OUTREACH ORGANIZATION
Practice Location Address:

15508 WILLET CT
MASCOTTE, FL
34753-9102

Practice Phone: 352-255-6458
Practice Fax:

1225401912 — LIFE CHANGE OUTREACH ORGANIZATION, INC
Practice Location Address:

15508 WILLET CT
MASCOTTE, FL
34753-9102

Practice Phone: 352-272-2799
Practice Fax: 352-410-6111

1538614540 — GRACE'S SUPPORT SERVICES, LLC
Practice Location Address:

15508 WILLET CT
MASCOTTE, FL
34753-9102

Practice Phone: 352-255-6458
Practice Fax:

1295035012 — ERIC J HENRY PT
Practice Location Address:

15877 SURFBIRD CT
MASCOTTE, FL
34753-9116

Practice Phone: 501-470-5320
Practice Fax:

1174825210 — LAZINA JOHANNAH THOMAS BA
Practice Location Address:

315 CAROL ST
MASCOTTE, FL
34753-9253

Practice Phone: 352-429-2551
Practice Fax:

1164783528 — SOUTH LAKE PRIMARY CARE P A
Practice Location Address:

219 W MYERS BLVD , SUITE C
MASCOTTE, FL
34753-9793

Practice Phone: 352-557-4840
Practice Fax: 352-557-4839

Directions to “ MRS. NABUCHI GRACE ANDERSON MHC” Practice Location

Language	Start Address	Practice Location

These directions are for planning purposes only. You may find that construction projects, traffic, or other events may cause road conditions to differ from the map results.

Copyright © 2007-2026 (Powered by Swiss Vault Engine), all rights reserved. HIPAA liability, trademark, document use and software licensing rules apply. All registered trademarks, used in the content, are the property of their owners. Your interactions with this site are in accordance with our Terms of Use and Privacy Policy.