Provider Demographics
NPI:1558716100
Name:GRANT, ROSA (MS)
Entity Type:Individual
Prefix:
First Name:ROSA
Middle Name:
Last Name:GRANT
Suffix:
Gender:F
Credentials:MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:350 N WASHINGTON AVE
Mailing Address - Street 2:SUITE K
Mailing Address - City:TITUSVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32796-5806
Mailing Address - Country:US
Mailing Address - Phone:321-222-0172
Mailing Address - Fax:888-859-2513
Practice Address - Street 1:350 N WASHINGTON AVE
Practice Address - Street 2:SUITE K
Practice Address - City:TITUSVILLE
Practice Address - State:FL
Practice Address - Zip Code:32796-5806
Practice Address - Country:US
Practice Address - Phone:321-222-0172
Practice Address - Fax:888-859-2513
Is Sole Proprietor?:No
Enumeration Date:2016-05-02
Last Update Date:2016-05-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator