Provider Demographics
NPI:1508458688
Name:GRIMES, YOLANDA ANTERNETT (LPN)
Entity Type:Individual
Prefix:MRS
First Name:YOLANDA
Middle Name:ANTERNETT
Last Name:GRIMES
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:YOLANDA
Other - Middle Name:ANTERNETT
Other - Last Name:GRIMES
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LPN
Mailing Address - Street 1:841 PRUDENTIAL DR STE 1241
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32207-8329
Mailing Address - Country:US
Mailing Address - Phone:904-803-8358
Mailing Address - Fax:888-676-4449
Practice Address - Street 1:841 PRUDENTIAL DR STE 1241
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32207-8329
Practice Address - Country:US
Practice Address - Phone:904-803-8358
Practice Address - Fax:888-676-4449
Is Sole Proprietor?:Yes
Enumeration Date:2021-02-09
Last Update Date:2021-02-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPN5185376164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse