Provider Demographics
NPI:1629318381
Name:GRANT, ZEALENE
Entity Type:Individual
Prefix:
First Name:ZEALENE
Middle Name:
Last Name:GRANT
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:166 BOB THOMAS CIR
Mailing Address - Street 2:
Mailing Address - City:SANFORD
Mailing Address - State:FL
Mailing Address - Zip Code:32771-3094
Mailing Address - Country:US
Mailing Address - Phone:407-878-9224
Mailing Address - Fax:407-878-2230
Practice Address - Street 1:166 BOB THOMAS CIR
Practice Address - Street 2:
Practice Address - City:SANFORD
Practice Address - State:FL
Practice Address - Zip Code:32771-3094
Practice Address - Country:US
Practice Address - Phone:407-878-9224
Practice Address - Fax:407-878-2230
Is Sole Proprietor?:No
Enumeration Date:2013-02-18
Last Update Date:2013-02-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL232966372600000X, 376J00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes376J00000XNursing Service Related ProvidersHomemaker
No372600000XNursing Service Related ProvidersAdult Companion
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL677283896Medicaid
FL677283898Medicaid