Provider Demographics
NPI:1275817512
Name:GRANT, EVA M (DO)
Entity Type:Individual
Prefix:
First Name:EVA
Middle Name:M
Last Name:GRANT
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:602 S HOWARD AVE
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33606-2413
Mailing Address - Country:US
Mailing Address - Phone:813-253-2113
Mailing Address - Fax:
Practice Address - Street 1:602 S HOWARD AVE
Practice Address - Street 2:
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33606-2413
Practice Address - Country:US
Practice Address - Phone:813-253-2113
Practice Address - Fax:907-377-1969
Is Sole Proprietor?:Yes
Enumeration Date:2011-10-05
Last Update Date:2021-02-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOS16087207Q00000X
IN02004277A207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty