Individual provider Active NPI

Mary Grace Evasco Vinson, FNP

  • Adult Health Nurse Practitioner
  • Crestview, FL
National Provider Identifier
1083303481
Registry record updated Sep 23, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Adult Health Nurse PractitionerTaxonomy code 363LA2200X
License
ARNP11026114 Issued in FL
Practice address
302 E James Lee Blvd
Crestview, FL 32539-2827
Phone
(302) 325-3928
NPI assigned
May 2, 2023
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Sep 23, 2025

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 5

Specialty (taxonomy)CodeLicenseStatePrimary
Nurse Practitioner 363L00000X 11026114 FL
Acute Care Nurse Practitioner 363LA2100X ARNP11026114 FL
Community Health Nurse Practitioner 363LC1500X ARNP11026114 FL
Family Nurse Practitioner 363LF0000X ARNP11026114 FL
Adult Health Nurse Practitioner 363LA2200X ARNP11026114 FL Primary

Addresses

Primary practice location

302 E James Lee Blvd
Crestview, FL 32539-2827

Mailing address

302 E James Lee Blvd
Crestview, FL 32539-2827
Phone (866) 389-2727

Other names 1

  • Grace Vinson Professional name

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in FL
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: Yes
  • Hospice: No
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20231227003340 FL Practitioner - Nurse Practitioner 9739539149 Reassigns benefits to 1 organization
Practice locations: Crestview, FL

Care Compare profile

Medicare Care Compare
Specialty
Nurse Practitioner
Education
Other, 2022
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Minuteclinic LLCGroup PAC ID 6709850241, 576 clinicians

Practice addresses (Care Compare)

302 E James Lee Blvd
Crestview, FL 32539-2827
Phone (866) 389-2727

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Nurse Practitioner

State licenses

LicenseStateTypeSpecialty
11026114FLMDNurse Practitioner
ARNP11026114FLMDFamily Nurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
Theoria Medical Nurse Practitioner CurrentSince Dec 28, 2024 Accepting new patients
Minuteclinic LLC Nurse Practitioner CurrentSince Oct 16, 2025 Accepting new patients
Theoria Medical Nurse Practitioner Past Accepting new patients

Locations

302 E James Lee Blvd
Crestview, FL 32539
Phone (850) 682-1002

701 Lake Port Blvd
Leesburg, FL 34748
Phone (352) 728-3366

121 W Macclenny Ave
Macclenny, FL 32063
Phone (904) 259-6380

12401 Miramar Pkwy
Miramar, FL 33027
Phone (954) 538-8473

1053 John Sims Pkwy E
Niceville, FL 32578
Phone (850) 768-0213

8765 S Dixie Hwy
Pinecrest, FL 33156
Phone (305) 740-6840

7599 W Sand Lake Rd
Sand Lake, FL 32819
Phone (407) 352-0943

Networks

  • Healthfirst Medicare Network H9678
  • Healthfirst Medicare Network H1722
  • Healthfirst Medicare Network H3359
  • Healthfirst Medicare Network H5989

Organizations & group practices 3

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1682985600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1758585600000",
    "number": "1083303481",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "302 E JAMES LEE BLVD",
            "city": "CRESTVIEW",
            "state": "FL",
            "postal_code": "325392827",
            "telephone_number": "866-389-2727"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "302 E JAMES LEE BLVD",
            "city": "CRESTVIEW",
            "state": "FL",
            "postal_code": "325392827",
            "telephone_number": "302-325-3928"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "VINSON",
        "first_name": "MARY GRACE",
        "middle_name": "EVASCO",
        "name_prefix": "Ms.",
        "credential": "FNP",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2023-05-02",
        "last_updated": "2025-09-23",
        "certification_date": "2025-09-23",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363L00000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner",
            "state": "FL",
            "license": "11026114",
            "primary": false
        },
        {
            "code": "363LA2100X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Acute Care",
            "state": "FL",
            "license": "ARNP11026114",
            "primary": false
        },
        {
            "code": "363LC1500X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Community Health",
            "state": "FL",
            "license": "ARNP11026114",
            "primary": false
        },
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "FL",
            "license": "ARNP11026114",
            "primary": false
        },
        {
            "code": "363LA2200X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Adult Health",
            "state": "FL",
            "license": "ARNP11026114",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "GRACE",
            "last_name": "VINSON",
            "code": "2",
            "type": "Professional Name"
        }
    ]
}

Other providers in Crestview, FL

Sources for this page

Verify at the official NPI Registry.