Provider Demographics
NPI:1144379488
Name:GROSS, JOHN (FNP)
Entity Type:Individual
Prefix:
First Name:JOHN
Middle Name:
Last Name:GROSS
Suffix:
Gender:M
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1009 WINDCROSS CT
Mailing Address - Street 2:STE 101
Mailing Address - City:FRANKLIN
Mailing Address - State:TN
Mailing Address - Zip Code:37067-2678
Mailing Address - Country:US
Mailing Address - Phone:615-224-5438
Mailing Address - Fax:855-247-8787
Practice Address - Street 1:1 PENN PLZ
Practice Address - Street 2:STE 725
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10119-0002
Practice Address - Country:US
Practice Address - Phone:718-646-3419
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-01-09
Last Update Date:2014-12-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DC1013851363LF0000X
NY334815363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily