Provider Demographics
NPI:1164759742
Name:GRANATA, JESSICA ERIN (DNP, FNP-C, PMHNP-BC)
Entity Type:Individual
Prefix:DR
First Name:JESSICA
Middle Name:ERIN
Last Name:GRANATA
Suffix:
Gender:F
Credentials:DNP, FNP-C, PMHNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:19609 ESTUARY DR
Mailing Address - Street 2:
Mailing Address - City:BOCA RATON
Mailing Address - State:FL
Mailing Address - Zip Code:33498-6202
Mailing Address - Country:US
Mailing Address - Phone:617-285-6198
Mailing Address - Fax:
Practice Address - Street 1:4575 LINTON BLVD
Practice Address - Street 2:
Practice Address - City:DELRAY BEACH
Practice Address - State:FL
Practice Address - Zip Code:33445-6606
Practice Address - Country:US
Practice Address - Phone:954-666-5301
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-11-03
Last Update Date:2023-03-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA19041363L00000X, 363LF0000X
MARN263331363LF0000X
FLARNP 9346569363LF0000X
FLARNP9346569363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
CACV997ZMedicare PIN