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NPI Code Detail

MEDICARE: KIMBERLY JILL GRANT APRN, PMHNP-BC

MEDICARE: KIMBERLY JILL GRANT APRN, PMHNP-BC
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
1363LP0808XPsychiatric/Mental Health Nurse PractitionerAPRN11007366FL

General Provider Information

NPI Number : 1902428568
Entity Type Code : Individual
Provider Name (Legal Business Name) : KIMBERLY JILL GRANT APRN, PMHNP-BC
Provider Business Mailing Address
First Line : 2055 REYKO RD STE 100
Second Line :
City : JACKSONVILLE
State : FL
Zip : 32207-2828
Country : US
Telephone Number : 904-648-8200
Fax Number : 904-253-3270
Provider Business Practice Location Address
First Line : 2055 REYKO RD STE 100
Second Line :
City : JACKSONVILLE
State : FL
Zip : 32207-2828
Country : US
Telephone Number : 904-648-8200
Fax Number : 904-253-3270
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 05/17/2020
Last Update Date : 06/10/2026

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Directions to “ KIMBERLY JILL GRANT APRN, PMHNP-BC” Practice Location

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