Provider Demographics
NPI:1396402780
Name:GRANT-ROJAS, ADRIANNA NICHOLLE
Entity Type:Individual
Prefix:MRS
First Name:ADRIANNA
Middle Name:NICHOLLE
Last Name:GRANT-ROJAS
Suffix:
Gender:F
Credentials:
Other - Prefix:MRS
Other - First Name:ADRIANNA
Other - Middle Name:NICHOLLE
Other - Last Name:GRANT-ROJAS
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:
Mailing Address - Street 1:6754 W FM 1161 RD
Mailing Address - Street 2:
Mailing Address - City:WHARTON
Mailing Address - State:TX
Mailing Address - Zip Code:77488-3751
Mailing Address - Country:US
Mailing Address - Phone:979-453-1476
Mailing Address - Fax:
Practice Address - Street 1:905 N GULF BLVD
Practice Address - Street 2:
Practice Address - City:FREEPORT
Practice Address - State:TX
Practice Address - Zip Code:77541-3907
Practice Address - Country:US
Practice Address - Phone:281-824-1480
Practice Address - Fax:281-220-6407
Is Sole Proprietor?:Yes
Enumeration Date:2021-11-21
Last Update Date:2023-07-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL11024778363LP0808X
TX1108257363LP0808X
TX925078163WP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No163WP0808XNursing Service ProvidersRegistered NursePsychiatric/Mental Health