Provider Demographics
NPI:1457454324
Name:GRAVES, VIVIENNE EVETTE (ARNP,DNP)
Entity Type:Individual
Prefix:
First Name:VIVIENNE
Middle Name:EVETTE
Last Name:GRAVES
Suffix:
Gender:F
Credentials:ARNP,DNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7305 N MILITARY TRL
Mailing Address - Street 2:
Mailing Address - City:RIVIERA BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33410-7417
Mailing Address - Country:US
Mailing Address - Phone:561-422-6957
Mailing Address - Fax:561-422-7220
Practice Address - Street 1:7305 N MILITARY TRL
Practice Address - Street 2:
Practice Address - City:RIVIERA BEACH
Practice Address - State:FL
Practice Address - Zip Code:33410-7417
Practice Address - Country:US
Practice Address - Phone:561-422-6957
Practice Address - Fax:561-422-7220
Is Sole Proprietor?:No
Enumeration Date:2006-09-06
Last Update Date:2014-04-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLARNP2988812363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
P52991Medicare UPIN
FLE7096ZMedicare PIN