Individual provider Active NPI

Jerris N Grover, APRN

  • Psychiatric/Mental Health Nurse Practitioner
  • Gainesville, FL
National Provider Identifier
1407002082
Registry record updated Aug 9, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Psychiatric/Mental Health Nurse PractitionerTaxonomy code 363LP0808X
License
ARNP 2826952 Issued in FL
Practice address
4300 SW 13TH St
Gainesville, FL 32608-4006
Phone
(352) 374-5600
Fax
(352) 224-2741
NPI assigned
Aug 14, 2008
Last updated
Aug 9, 2023By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Aug 9, 2023

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Psychiatric/Mental Health Nurse Practitioner 363LP0808X ARNP 2826952 FL Primary
Mental Health Counselor 101YM0800X NU

Addresses

Primary practice location

4300 SW 13TH St
Gainesville, FL 32608-4006

Mailing address

4300 SW 13TH St
Gainesville, FL 32608-4006
Phone (352) 374-5600

Other identifiers 1

IdentifierTypeStateIssuer
766368400MedicaidFL

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file
Eligible to order & refer
  • Part B services: No
  • Medical equipment: Yes
  • Home health: No
  • Power mobility devices: Yes
  • Hospice: No
Green means eligible to order or refer.

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
ARNP 2826952FLMDPsychiatric/Mental Health Nurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
Florida Therapy Services, Inc CurrentSince Jul 17, 2021 Accepting new patients
Life Management of NW FL, Inc. Past Accepting new patients
Life Management of NW FL, Inc. Past Accepting new patients

Locations

6425 Pensacola Blvd
#13
Pensacola, FL 32505
Phone (850) 471-0017

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, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

NPI Registry JSON

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

{
    "created_epoch": "1218672000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1691539200000",
    "number": "1407002082",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4300 SW 13TH ST",
            "city": "GAINESVILLE",
            "state": "FL",
            "postal_code": "326084006",
            "telephone_number": "352-374-5600",
            "fax_number": "352-224-2741"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4300 SW 13TH ST",
            "city": "GAINESVILLE",
            "state": "FL",
            "postal_code": "326084006",
            "telephone_number": "352-374-5600",
            "fax_number": "352-224-2741"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "GROVER",
        "first_name": "JERRIS",
        "middle_name": "N",
        "credential": "APRN",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2008-08-14",
        "last_updated": "2023-08-09",
        "certification_date": "2023-08-09",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LP0808X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Psychiatric/Mental Health",
            "state": "FL",
            "license": "ARNP 2826952",
            "primary": true
        },
        {
            "code": "101YM0800X",
            "taxonomy_group": "",
            "desc": "Counselor, Mental Health",
            "state": "NU",
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "766368400",
            "state": "FL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Gainesville, FL

Sources for this page

Verify at the official NPI Registry.