Grandin Family Practice LLC
Organization Active NPI General Practice Physician · Grandin, FL
NPI 1902098296 · NPPES record last updated Aug 10, 2007
Key facts
- NPI
- 1902098296
- Entity type
- Organization (NPI type 2)
- Primary specialty
- General Practice Physician 208D00000X
- License
- 0065809 (FL)
- Legal business name
- GRANDIN FAMILY PRACTICE LLC
- Practice address
- 1326 Sr 100
Grandin, FL 32138-0129 - Phone
- (386) 659-2104
- Fax
- (386) 659-2196
- NPI assigned
- Aug 10, 2007
- Organization subpart
- No
Authorized official
- Name
- Anita Lenas
- Title
- Owner/Operator
- Phone
- (386) 659-2104
National Provider Directory
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| General Practice Physician |
208D00000X | 0065809 | FL | Yes |
Addresses
Primary practice location
1326 Sr 100
Grandin, FL 32138-0129
Mailing address
PO Box 380129
Grandin, FL 32138-0129
Phone (386) 659-2104
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 00485 | Other | FL | BCBS |
Other providers in Grandin, FL
All providers in Grandin, FL · General Practice Physician in Florida
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Aug 10, 2007. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.