Provider Demographics
NPI:1992359038
Name:JOSEPH, GRACE MARIA (APRN)
Entity type:Individual
Prefix:
First Name:GRACE
Middle Name:MARIA
Last Name:JOSEPH
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:GRACE
Other - Middle Name:MARIA
Other - Last Name:JOHN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:2995 DREW ST
Mailing Address - Street 2:
Mailing Address - City:CLEARWATER
Mailing Address - State:FL
Mailing Address - Zip Code:33759-3012
Mailing Address - Country:US
Mailing Address - Phone:727-315-7496
Mailing Address - Fax:
Practice Address - Street 1:18600 FERNVIEW ST STE 102
Practice Address - Street 2:
Practice Address - City:LAND O LAKES
Practice Address - State:FL
Practice Address - Zip Code:34638-6231
Practice Address - Country:US
Practice Address - Phone:813-692-8044
Practice Address - Fax:813-605-6184
Is Sole Proprietor?:No
Enumeration Date:2019-07-26
Last Update Date:2024-07-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAPRN11001847363LG0600X, 363LA2100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LG0600XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGerontology
No363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLAPRN11001847OtherFLORIDA BOARD OF NURSING