Provider Demographics
NPI:1104132018
Name:GRANGER, LINDSEY LEIGH (ARNP)
Entity type:Individual
Prefix:MS
First Name:LINDSEY
Middle Name:LEIGH
Last Name:GRANGER
Suffix:
Gender:F
Credentials:ARNP
Other - Prefix:
Other - First Name:LINDSEY
Other - Middle Name:LEIGH
Other - Last Name:GAVIN-GARN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:P.O. BOX 191
Mailing Address - Street 2:PROVIDER ENROLLMENT DEPARTMENT,
Mailing Address - City:ROCKLAND
Mailing Address - State:DE
Mailing Address - Zip Code:19732-0191
Mailing Address - Country:US
Mailing Address - Phone:302-298-7371
Mailing Address - Fax:302-651-4945
Practice Address - Street 1:13535 NEMOURS PARKWAY
Practice Address - Street 2:NEMOURS CHILDRENS HOSPITAL,
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32827-7402
Practice Address - Country:US
Practice Address - Phone:407-567-4000
Practice Address - Fax:407-650-7277
Is Sole Proprietor?:No
Enumeration Date:2010-08-30
Last Update Date:2015-09-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLARNP9268813363LP0200X
FLARNP9407864363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics