Provider Demographics
NPI:1295217156
Name:GRAY, JHONNARRI
Entity Type:Individual
Prefix:
First Name:JHONNARRI
Middle Name:
Last Name:GRAY
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2800 W OAKLAND PARK BLVD STE 203
Mailing Address - Street 2:
Mailing Address - City:OAKLAND PARK
Mailing Address - State:FL
Mailing Address - Zip Code:33311-1307
Mailing Address - Country:US
Mailing Address - Phone:954-530-4363
Mailing Address - Fax:
Practice Address - Street 1:2800 W OAKLAND PARK BLVD STE 203
Practice Address - Street 2:
Practice Address - City:OAKLAND PARK
Practice Address - State:FL
Practice Address - Zip Code:33311-1307
Practice Address - Country:US
Practice Address - Phone:954-530-4363
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-09-06
Last Update Date:2018-09-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL4617374U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes374U00000XNursing Service Related ProvidersHome Health AideGroup - Single Specialty