Provider Demographics
NPI:1639767478
Name:HERRERA, GRACE A (APRN FNP-C)
Entity Type:Individual
Prefix:
First Name:GRACE
Middle Name:A
Last Name:HERRERA
Suffix:
Gender:F
Credentials:APRN FNP-C
Other - Prefix:
Other - First Name:GRACE
Other - Middle Name:A
Other - Last Name:HERRERA-YAMASHITA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:APRN
Mailing Address - Street 1:6555 CHESTER AVE STE 1
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32217-2279
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:6555 CHESTER AVE STE 1
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32217-2279
Practice Address - Country:US
Practice Address - Phone:904-309-6504
Practice Address - Fax:904-503-3577
Is Sole Proprietor?:Yes
Enumeration Date:2021-01-07
Last Update Date:2021-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAPRN11011087363LF0000X, 363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily