Grace Family Practice

Primary specialty

Primary Care Clinic/CenterTaxonomy code 261QP2300X

Legal business name

GRACE FAMILY PRACTICE

Doing business as

Graceland Family Practice

Practice address

6470 Tippin Ave
Pensacola, FL 32504-8143

Phone

(850) 741-2878

NPI assigned

Oct 22, 2020

Organization subpart

No

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

Authorized official

Name

Mrs. Debra Ann Fickling, APRN, FNP-CNPI 1184196669

Title

Provider

Phone

(850) 741-2878

Specialties & licenses 1

Addresses

Other identifiers 1

Other names 1

• Graceland Family Practice Doing business as

Medicare fee-for-service enrollment

Enrolled in FL

Enrollment records 1

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

Locations

Practitioners 1

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

• Debra Ann Fickling, FNP-C

  • Family Nurse Practitioner
  • Pensacola, FL
  • NPI 1184196669
  Medicare reassignment NPD Authorized official

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

{
    "created_epoch": "1603324800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1603324800000",
    "number": "1932708617",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "6470 TIPPIN AVE",
            "city": "PENSACOLA",
            "state": "FL",
            "postal_code": "325048143",
            "telephone_number": "850-741-2878"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "6470 TIPPIN AVE",
            "city": "PENSACOLA",
            "state": "FL",
            "postal_code": "325048143",
            "telephone_number": "850-741-2878"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "GRACE FAMILY PRACTICE",
        "organizational_subpart": "NO",
        "enumeration_date": "2020-10-22",
        "last_updated": "2020-10-22",
        "certification_date": "2020-10-22",
        "status": "A",
        "authorized_official_last_name": "FICKLING",
        "authorized_official_first_name": "DEBRA",
        "authorized_official_middle_name": "ANN",
        "authorized_official_title_or_position": "PROVIDER",
        "authorized_official_telephone_number": "850-741-2878",
        "authorized_official_name_prefix": "Mrs.",
        "authorized_official_credential": "APRN, FNP-C"
    },
    "taxonomies": [
        {
            "code": "261QP2300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Primary Care",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1184196669",
            "state": "FL"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Graceland Family Practice",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Kristen-Kaye Goulbourne
• Patrick Joseph Gould, LMHC
• Karinne Gouveia
• Gale G. Goyins, M.D.
• Grace Care Medical LLC
• Grace Medical, Inc. (AeroCare)
• Larquita Shree Grace
• Sally Maloney Grace, ARNP
• Graceland Family Practice
• Morgan Gradia

• Primary Care Clinic/Center in Pensacola, FL
• Providers in Pensacola, FL by specialty
• Primary Care Clinic/Center in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 22, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.