MEDICARE: MRS. KIMBERLY MICHELLE GRANT 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	363LA2200X	Adult Health Nurse Practitioner	ARNP9227413	FL
2	363LA2100X	Acute Care Nurse Practitioner	APRN9227413	FL

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
2	NU386	OTHER	FL	MEDICARE HF

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
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1992082150
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. KIMBERLY MICHELLE GRANT ARNP

Provider Business Mailing Address
First Line	:	1115 E. RIDGEWOOD ST.
Second Line	:
City	:	ORLANDO
State	:	FL
Zip	:	32803
Country	:	US
Telephone Number	:	407-841-1100
Fax Number	:	407-650-0262

Provider Business Practice Location Address
First Line	:	661 E ALTAMONTE DR STE 324
Second Line	:
City	:	ALTAMONTE SPRINGS
State	:	FL
Zip	:	32701-5103
Country	:	US
Telephone Number	:	407-845-8354
Fax Number	:	407-645-5355

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

Provider Enumeration Date	:	11/15/2011
Last Update Date	:	06/12/2025

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Directions to “ MRS. KIMBERLY MICHELLE GRANT ARNP” Practice Location

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