Provider Demographics
NPI:1578089850
Name:GRISHAM, TORY L (NP)
Entity Type:Individual
Prefix:MRS
First Name:TORY
Middle Name:L
Last Name:GRISHAM
Suffix:
Gender:F
Credentials:NP
Other - Prefix:MS
Other - First Name:TORY
Other - Middle Name:LEIGH
Other - Last Name:HOELSCHER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:NP
Mailing Address - Street 1:PO BOX 9007
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTESVILLE
Mailing Address - State:VA
Mailing Address - Zip Code:22906-9007
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1222 JEFFERSON PARK AVE
Practice Address - Street 2:
Practice Address - City:CHARLOTTESVILLE
Practice Address - State:VA
Practice Address - Zip Code:22903-3410
Practice Address - Country:US
Practice Address - Phone:434-982-3040
Practice Address - Fax:434-245-3535
Is Sole Proprietor?:No
Enumeration Date:2017-08-17
Last Update Date:2023-11-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0024175156207R00000X, 363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine