Active NPI
Amazing Grace Primary Care, LLC
- Family Nurse Practitioner
- Chiefland, FL
National Provider Identifier
1821702663
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Family Nurse Practitioner
- 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
Registry information is reported by the provider to CMS and is not verified. About this source
Authorized official
- Name
- Sally Martinez, FNP-BC, DNP
- 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) | Code | License | State | Primary |
|---|---|---|---|---|
| Family Nurse Practitioner | 363LF0000X | Primary | ||
| Women's Health Nurse Practitioner | 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 ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20230330000618 | FL | Part B Supplier - Clinic/Group Practice | 7517331770 |
Receives reassigned benefits from 1 practitioner Practice locations: Chiefland, FL |
National Provider Directory
National Provider DirectoryPractitioners & 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.