Provider Demographics
NPI:1306319538
Name:GRIMES, HALLIE ELIZABETH
Entity type:Individual
Prefix:
First Name:HALLIE
Middle Name:ELIZABETH
Last Name:GRIMES
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8290 GATE PKWY W UNIT 415
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32216-3639
Mailing Address - Country:US
Mailing Address - Phone:813-480-0147
Mailing Address - Fax:
Practice Address - Street 1:8290 GATE PKWY W UNIT 415
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32216-3639
Practice Address - Country:US
Practice Address - Phone:813-480-0147
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-01-10
Last Update Date:2019-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic TrainerGroup - Multi-Specialty