Organization Active NPI

Amazing Grace Primary Care, LLC

  • Family Nurse Practitioner
  • Chiefland, FL
National Provider Identifier
1821702663
Registry record updated Dec 17, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Nurse PractitionerTaxonomy code 363LF0000X
Legal business name
AMAZING GRACE PRIMARY CARE, LLC
Practice address
110 E Park Ave
Chiefland, FL 32626-0901
Phone
(352) 949-0478
Fax
(352) 752-3305
NPI assigned
Jan 6, 2023
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Dec 17, 2025

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

Authorized official

Name
Sally Martinez, FNP-BC, DNPNPI 1720235864
Title
Ceo
Phone
(352) 339-8981

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Family Nurse PractitionerGroup: 193200000X MULTI-SPECIALTY GROUP 363LF0000X Primary
Women's Health Nurse PractitionerGroup: 193200000X MULTI-SPECIALTY GROUP 363LW0102X

Addresses

Primary practice location

110 E Park Ave
Chiefland, FL 32626-0901

Mailing address

110 E Park Ave
Chiefland, FL 32626-0901
Phone (352) 949-0478

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in FL

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20230330000618 FL Part B Supplier - Clinic/Group Practice 7517331770 Receives reassigned benefits from 1 practitioner
Practice locations: Chiefland, FL

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1672963200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1765929600000",
    "number": "1821702663",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "110 E PARK AVE",
            "city": "CHIEFLAND",
            "state": "FL",
            "postal_code": "326260901",
            "telephone_number": "352-949-0478",
            "fax_number": "352-754-3305"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "110 E PARK AVE",
            "city": "CHIEFLAND",
            "state": "FL",
            "postal_code": "326260901",
            "telephone_number": "352-949-0478",
            "fax_number": "352-752-3305"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "AMAZING GRACE PRIMARY CARE, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2023-01-06",
        "last_updated": "2025-12-17",
        "certification_date": "2025-12-17",
        "status": "A",
        "authorized_official_last_name": "MARTINEZ",
        "authorized_official_first_name": "SALLY",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "352-339-8981",
        "authorized_official_credential": "FNP-BC, DNP"
    },
    "taxonomies": [
        {
            "code": "363LF0000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Nurse Practitioner, Family",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "363LW0102X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Nurse Practitioner, Women's Health",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Chiefland, FL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 17, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.