Provider Demographics
NPI:1164191607
Name:GREY, JANICE N
Entity Type:Individual
Prefix:MS
First Name:JANICE
Middle Name:N
Last Name:GREY
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 1:200 FRANDORSON CIR STE 204
Mailing Address - Street 2:
Mailing Address - City:APOLLO BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33572-2691
Mailing Address - Country:US
Mailing Address - Phone:813-421-0687
Mailing Address - Fax:813-433-5305
Practice Address - Street 1:200 FRANDORSON CIR STE 204
Practice Address - Street 2:
Practice Address - City:APOLLO BEACH
Practice Address - State:FL
Practice Address - Zip Code:33572-2691
Practice Address - Country:US
Practice Address - Phone:813-421-0687
Practice Address - Fax:813-433-5305
Is Sole Proprietor?:Yes
Enumeration Date:2021-09-08
Last Update Date:2021-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLRN9166804163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes163W00000XNursing Service ProvidersRegistered NurseGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL107545800Medicaid