Provider Demographics
NPI:1083955793
Name:GRANT, LYNTRESSA DANIELLE (PMHNP-BC)
Entity Type:Individual
Prefix:DR
First Name:LYNTRESSA
Middle Name:DANIELLE
Last Name:GRANT
Suffix:
Gender:F
Credentials:PMHNP-BC
Other - Prefix:DR
Other - First Name:LYNTRESSA
Other - Middle Name:DANIELLE
Other - Last Name:GRANT
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:DNP, PMHNP-BC
Mailing Address - Street 1:11100 SW 93RD COURT RD
Mailing Address - Street 2:SUITE 10-BOX 118
Mailing Address - City:OCALA
Mailing Address - State:FL
Mailing Address - Zip Code:34481
Mailing Address - Country:US
Mailing Address - Phone:833-437-5433
Mailing Address - Fax:833-999-0975
Practice Address - Street 1:111 SW 5TH AVE
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97204-3604
Practice Address - Country:US
Practice Address - Phone:866-277-9071
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-03-05
Last Update Date:2024-03-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLARNP9236028363LP0808X
OR201509160NP-PP363LP0808X
AZAP5646363LP0808X
SCAPN24094363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
ORDMAP500698768Medicaid
FL009044300Medicaid
AZ030323Medicaid
FL009044300Medicaid