Provider Demographics
NPI:1962404277
Name:GRANT, JOYLYN MARIE (NP)
Entity type:Individual
Prefix:MRS
First Name:JOYLYN
Middle Name:MARIE
Last Name:GRANT
Suffix:
Gender:F
Credentials:NP
Other - Prefix:MS
Other - First Name:JOYLYN
Other - Middle Name:MAREI
Other - Last Name:KRICK
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:NP
Mailing Address - Street 1:13041 MONTEREY ESTATES DR
Mailing Address - Street 2:
Mailing Address - City:HERNDON
Mailing Address - State:VA
Mailing Address - Zip Code:20171-2638
Mailing Address - Country:US
Mailing Address - Phone:703-326-0858
Mailing Address - Fax:
Practice Address - Street 1:2616 SHERWOOD HALL LN
Practice Address - Street 2:STE 203
Practice Address - City:ALEXANDRIA
Practice Address - State:VA
Practice Address - Zip Code:22306-3154
Practice Address - Country:US
Practice Address - Phone:703-360-0594
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-06-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0024165962363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily