Provider Demographics
NPI:1194711556
Name:GRANTHON, JUSTINA J (ARNP)
Entity type:Individual
Prefix:
First Name:JUSTINA
Middle Name:J
Last Name:GRANTHON
Suffix:
Gender:F
Credentials:ARNP
Other - Prefix:
Other - First Name:JUSTINA
Other - Middle Name:J
Other - Last Name:HATHAWAY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:ARNP
Mailing Address - Street 1:PO BOX 5699
Mailing Address - Street 2:
Mailing Address - City:SARASOTA
Mailing Address - State:FL
Mailing Address - Zip Code:34277-5699
Mailing Address - Country:US
Mailing Address - Phone:941-365-0433
Mailing Address - Fax:941-954-2064
Practice Address - Street 1:1851 HAWTHORNE ST
Practice Address - Street 2:
Practice Address - City:SARASOTA
Practice Address - State:FL
Practice Address - Zip Code:34239-2945
Practice Address - Country:US
Practice Address - Phone:941-365-0433
Practice Address - Fax:941-954-2064
Is Sole Proprietor?:No
Enumeration Date:2005-09-21
Last Update Date:2010-08-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLARNP3186272363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL306974500Medicaid
FL306974500Medicaid
FLU1849YMedicare ID - Type Unspecified