Provider Demographics
NPI:1093450256
Name:COKE, GRACIE-ANN NATAUYA
Entity Type:Individual
Prefix:
First Name:GRACIE-ANN
Middle Name:NATAUYA
Last Name:COKE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5249 MILLENIA BLVD APT 109
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32839-6176
Mailing Address - Country:US
Mailing Address - Phone:570-415-2345
Mailing Address - Fax:
Practice Address - Street 1:5249 MILLENIA BLVD APT 109
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32839-6176
Practice Address - Country:US
Practice Address - Phone:570-415-2345
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-05-02
Last Update Date:2022-05-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes376J00000XNursing Service Related ProvidersHomemaker
No251E00000XAgenciesHome Health