Individual provider Active NPI

Therese Monica Grandlienard

  • Family Nurse Practitioner
  • Largo, FL
National Provider Identifier
1568822716
Registry record updated Jun 14, 2016
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Nurse PractitionerTaxonomy code 363LF0000X
License
9280102 Issued in FL
Practice address
11200 Seminole Blvd
Largo, FL 33778-3259
Phone
(727) 258-4817
NPI assigned
Mar 1, 2016
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jun 14, 2016

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Nurse Practitioner 363LF0000X 9280102 FL Primary

Addresses

Primary practice location

11200 Seminole Blvd
Largo, FL 33778-3259

Mailing address

4030 3Rd Ave N
Saint Petersburg, FL 33713-7402

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.

Care Compare profile

Medicare Care Compare
Specialty
Nurse Practitioner
Education
Other, 2015
Medicare assignment
Accepts the Medicare-approved amount as payment in full

Practice addresses (Care Compare)

12450 Roosevelt Blvd
Suite 101
St Petersburg, FL 33716-1902

Hospital & facility affiliations

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
9280102FLMDFamily Nurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
West Coast Primary Care, LLC CurrentSince Jan 1, 2022 Accepting new patients
Healthnow Urgent Care, L.L.C. PastSince Sep 1, 2010 Accepting new patients
SC Physicians LLC PastSince Jan 1, 2022 Accepting new patients

Locations

12450 Roosevelt Blvd N
Ste 101
St Petersburg, FL 33716
Phone (727) 571-1688

Interoperability endpoints

  • FHIR API: https://fhir4.healow.com/fhir/r4/HIGJBA

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.

Hospital & facility affiliations 4

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

NPI Registry JSON

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

{
    "created_epoch": "1456790400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1465862400000",
    "number": "1568822716",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4030 3RD AVE N",
            "city": "SAINT PETERSBURG",
            "state": "FL",
            "postal_code": "337137402"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "11200 SEMINOLE BLVD",
            "city": "LARGO",
            "state": "FL",
            "postal_code": "337783259",
            "telephone_number": "727-258-4817"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "GRANDLIENARD",
        "first_name": "THERESE",
        "middle_name": "MONICA",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2016-03-01",
        "last_updated": "2016-06-14",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "FL",
            "license": "9280102",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Largo, FL

Sources for this page

Verify at the official NPI Registry.