Provider Demographics
NPI:1619212834
Name:TURNER, GRACIE A (DO)
Entity Type:Individual
Prefix:
First Name:GRACIE
Middle Name:A
Last Name:TURNER
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:GRACIE
Other - Middle Name:A
Other - Last Name:BLUM
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:900 SE OCEAN BLVD STE 215B
Mailing Address - Street 2:
Mailing Address - City:STUART
Mailing Address - State:FL
Mailing Address - Zip Code:34994-2471
Mailing Address - Country:US
Mailing Address - Phone:772-781-5434
Mailing Address - Fax:772-403-9228
Practice Address - Street 1:900 SE OCEAN BLVD STE 215B
Practice Address - Street 2:
Practice Address - City:STUART
Practice Address - State:FL
Practice Address - Zip Code:34994-2471
Practice Address - Country:US
Practice Address - Phone:772-781-5434
Practice Address - Fax:772-223-5789
Is Sole Proprietor?:Yes
Enumeration Date:2012-11-28
Last Update Date:2022-05-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOS 11965207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL14WP1OtherFLORIDA BLUE
FL012645800Medicaid
FLHX295ZMedicare PIN