Provider Demographics
NPI:1083017156
Name:GRICE, LA-SHERIA LAMARRA (APRN)
Entity Type:Individual
Prefix:
First Name:LA-SHERIA
Middle Name:LAMARRA
Last Name:GRICE
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:LA-SHERIA
Other - Middle Name:
Other - Last Name:THOMAS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:23343 NW COUNTY ROAD 236
Mailing Address - Street 2:
Mailing Address - City:HIGH SPRINGS
Mailing Address - State:FL
Mailing Address - Zip Code:32643-9669
Mailing Address - Country:US
Mailing Address - Phone:386-454-0698
Mailing Address - Fax:
Practice Address - Street 1:103 US HWY 27 SW
Practice Address - Street 2:
Practice Address - City:BRANFORD
Practice Address - State:FL
Practice Address - Zip Code:32008-3048
Practice Address - Country:US
Practice Address - Phone:386-935-3090
Practice Address - Fax:386-935-3198
Is Sole Proprietor?:No
Enumeration Date:2014-10-03
Last Update Date:2024-04-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLRN9386592163W00000X
FLAPRN11032082363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No163W00000XNursing Service ProvidersRegistered Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL94815546063Medicaid