Provider Demographics
NPI:1124712369
Name:GRIMSLEY, ONVIA Y (CNA)
Entity type:Individual
Prefix:
First Name:ONVIA
Middle Name:Y
Last Name:GRIMSLEY
Suffix:
Gender:F
Credentials:CNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8284 REDCEDAR PL
Mailing Address - Street 2:
Mailing Address - City:PORT ST LUCIE
Mailing Address - State:FL
Mailing Address - Zip Code:34952-2613
Mailing Address - Country:US
Mailing Address - Phone:772-227-0157
Mailing Address - Fax:
Practice Address - Street 1:8284 REDCEDAR PL
Practice Address - Street 2:
Practice Address - City:PORT ST LUCIE
Practice Address - State:FL
Practice Address - Zip Code:34952-2613
Practice Address - Country:US
Practice Address - Phone:772-333-2021
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-06-08
Last Update Date:2023-06-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
311ZA0620X
FL257428251J00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251J00000XAgenciesNursing Care
No311ZA0620XNursing & Custodial Care FacilitiesCustodial Care FacilityAdult Care Home