Provider Demographics
NPI:1861198608
Name:GIFFORD, GRACE (RN)
Entity type:Individual
Prefix:
First Name:GRACE
Middle Name:
Last Name:GIFFORD
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13796 COVEY RUN PL
Mailing Address - Street 2:
Mailing Address - City:SPRING HILL
Mailing Address - State:FL
Mailing Address - Zip Code:34609-0658
Mailing Address - Country:US
Mailing Address - Phone:352-232-5902
Mailing Address - Fax:
Practice Address - Street 1:7551 FOREST OAKS BLVD
Practice Address - Street 2:
Practice Address - City:SPRING HILL
Practice Address - State:FL
Practice Address - Zip Code:34606-2437
Practice Address - Country:US
Practice Address - Phone:352-540-6897
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-02-02
Last Update Date:2023-02-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLRN9352385163WC1500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WC1500XNursing Service ProvidersRegistered NurseCommunity Health