Provider Demographics
NPI:1700195468
Name:GRANTLAND, JOY NICOLE (PA-C)
Entity Type:Individual
Prefix:MS
First Name:JOY
Middle Name:NICOLE
Last Name:GRANTLAND
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:304 NORTH ST
Mailing Address - Street 2:SUITE 4
Mailing Address - City:ELKTON
Mailing Address - State:MD
Mailing Address - Zip Code:21921-5570
Mailing Address - Country:US
Mailing Address - Phone:410-398-8899
Mailing Address - Fax:410-398-1477
Practice Address - Street 1:304 NORTH ST
Practice Address - Street 2:SUITE 4
Practice Address - City:ELKTON
Practice Address - State:MD
Practice Address - Zip Code:21921-5570
Practice Address - Country:US
Practice Address - Phone:410-398-8899
Practice Address - Fax:410-398-1477
Is Sole Proprietor?:No
Enumeration Date:2010-09-29
Last Update Date:2010-09-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDC0004307363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant