Provider Demographics
NPI:1508586967
Name:GRANT, TERRI-ANN K (FNP-BC)
Entity Type:Individual
Prefix:
First Name:TERRI-ANN
Middle Name:K
Last Name:GRANT
Suffix:
Gender:F
Credentials:FNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:18-20 LACKAWANNA PLZ STE 300
Mailing Address - Street 2:
Mailing Address - City:MONTCLAIR
Mailing Address - State:NJ
Mailing Address - Zip Code:07042-3642
Mailing Address - Country:US
Mailing Address - Phone:551-204-6051
Mailing Address - Fax:
Practice Address - Street 1:18-20 LACKAWANNA PLZ STE 300
Practice Address - Street 2:
Practice Address - City:MONTCLAIR
Practice Address - State:NJ
Practice Address - Zip Code:07042-3642
Practice Address - Country:US
Practice Address - Phone:551-204-6051
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-08-29
Last Update Date:2022-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ2021207711207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine