Provider Demographics
NPI:1104852508
Name:GRISSINGER, MARGARET MARY (CRNA)
Entity Type:Individual
Prefix:MS
First Name:MARGARET
Middle Name:MARY
Last Name:GRISSINGER
Suffix:
Gender:F
Credentials:CRNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12230 FRANKLIN BROOK LN S
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32225-5186
Mailing Address - Country:US
Mailing Address - Phone:904-472-0484
Mailing Address - Fax:
Practice Address - Street 1:12230 FRANKLIN BROOK LN S
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32225-5186
Practice Address - Country:US
Practice Address - Phone:904-472-0484
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-06-25
Last Update Date:2017-02-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLARNP1615992367500000X
NVCRNA000242367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL018633300Medicaid
FL307078600Medicaid
FLP00672636Medicare PIN
FL018633300Medicaid
FLG3799WMedicare PIN