GRACE PEDIATRICS PL NPI 1720362429

NPI Information

  • NPI: 1720362429
  • Provider Name: GRACE PEDIATRICS PL
  • Classification: Nurse Practitioner - 363LP0200X
  • Specialization: Pediatrics
  • Entity Type: Organization
  • CLIA Number: 10D2037940
  • Address: 4196 W US HIGHWAY 90
    SUITE 105
    LAKE CITY, FL
    ZIP 32055
  • Phone: (386) 243-8474

Map and Directions

Get Directions

NPI Details

GRACE PEDIATRICS PL is a pediatrics nurse practitioner in Lake City, FL. GRACE PEDIATRICS PL NPI is 1720362429. The provider is registered as an organization entity type and is a multiple single specialty group.

The provider's business location address is:

4196 W US HIGHWAY 90
SUITE 105
LAKE CITY, FL
ZIP 32055-834
Phone: (386) 243-8474
Fax: (386) 438-5945

The provider's authorized official is Colleen Thompson .
The authorized official title is Manager/arnp/co-owner and has the following contact phone number (386) 243-8474.

The CLIA number assigned to this NPI record is 10D2037940 - physician office with a certificate type of Certificate of Waiver.

The enumeration date for this NPI number is 9/29/2011 and was last updated on 2/19/2014.

Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No. Taxonomy Code Taxonomy Clasification Taxonomy Specialization License Number License State Primary
1363LP0200XNurse PractitionerPediatrics9220069FLORIDANo
2363LP0200XNurse PractitionerPediatrics2667852FLORIDAYes

Other Identifiers

The following information regarding additional identifiers associated to this NPI record includes the other identifier number, identifier type, identifier state and issuer.

No. Other Provider Identifier Other Provider Identifier Type Other Provider Identifier State Other Provider Identifier Issuer
168-3810OTHERFLORIDAMEDICARE RHC CERTIFICATION
2004797600MEDICAIDFLORIDA

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 3/30/2025

NPI Synchronization or Removal

All materials and services on this site are provided on an "as is" and "as available" basis without warranty of any kind. The NPI record is maintained by the National Plan & Provider Enumeration System (NPPES) and anyone may request this information and other NPPES health care provider data from HHS under The Freedom of Information Act (FOIA), Title 5 of the United States Code, section 552. To update the NPI records please contact the NPPES.

Previous NPI
Next NPI