Hariette Alisia Graham, FNP
Individual provider Active NPI Family Nurse Practitioner · Cutler Bay, FL
NPI 1245819937 · NPPES record last updated Apr 7, 2021
Key facts
- NPI
- 1245819937
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Family Nurse Practitioner 363LF0000X
- License
- 11004463 (FL)
- Practice address
- 9310 SW 221St St
Cutler Bay, FL 33190-1448 - Phone
- (917) 535-6978
- NPI assigned
- Apr 7, 2021
- Sex
- Female
- Sole proprietor
- Yes
Organizations & group practices 2
Medicare Care Compare profile
- Specialty
- Nurse Practitioner
- Education
- Other, 2019
- Medicare assignment
- Accepts the Medicare-approved amount as payment in full
- Group practices
- Florida Department of Health
Practice addresses (Care Compare)
1845 Holsonback Dr
Daytona Beach, FL 32117-5114
Phone (386) 274-0500
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in FL
- Eligible to order & refer
- Part B services: Yes · DME: Yes · Home health: Yes · Power mobility devices: Yes · Hospice: No
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20240916003996 | FL | Practitioner - Nurse Practitioner | 5597206672 | Reassigns benefits to 1 organization |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
- Credentials
- Nurse Practitioner
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 11004463 | FL | MD | Family Nurse Practitioner |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Florida Department of Health | Single Specialty | Current |
Accepting new patients |
| Florida Department of Health | Single Specialty | Current |
Accepting new patients |
Locations
1845 Holsonback Dr
Daytona Beach, FL 32117
Phone (386) 274-0500
717 Canal St
New Smyrna Beach, FL 32168
Phone (386) 274-0500
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Family Nurse Practitioner |
363LF0000X | 11004463 | FL | Yes |
Addresses
Primary practice location
9310 SW 221St St
Cutler Bay, FL 33190-1448
Mailing address
9310 SW 221St St
Cutler Bay, FL 33190-1448
Phone (917) 535-6978
Other names
- Hariette Alisia Graham
Other providers in Cutler Bay, FL
- Yamilet Gonzalez
- Good Quality Life Therapy Corp
- Good Time Home Care Corp
- Eva Gordon
- Ruben Govea
- Leslie Jerald Granberry Jr.
- Martha Maria Granja Serru
- Evan Clark Grant
- Lavonia Grant
- Lisdenia Guanche
All providers in Cutler Bay, FL · Family Nurse Practitioner in Florida
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Apr 7, 2021. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Order and Referring (CMS).
- Medicare Care Compare provider data (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.