Provider Demographics
NPI:1790035814
Name:ERVIN, ERICA R GRANT (NP)
Entity Type:Individual
Prefix:MRS
First Name:ERICA
Middle Name:R GRANT
Last Name:ERVIN
Suffix:
Gender:F
Credentials:NP
Other - Prefix:MS
Other - First Name:ERICA
Other - Middle Name:R
Other - Last Name:GRANT
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:NP
Mailing Address - Street 1:240 NEW BYHALIA RD
Mailing Address - Street 2:
Mailing Address - City:COLLIERVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:38017-3716
Mailing Address - Country:US
Mailing Address - Phone:901-492-4920
Mailing Address - Fax:901-492-4921
Practice Address - Street 1:240 NEW BYHALIA RD
Practice Address - Street 2:
Practice Address - City:COLLIERVILLE
Practice Address - State:TN
Practice Address - Zip Code:38017-3716
Practice Address - Country:US
Practice Address - Phone:901-492-4920
Practice Address - Fax:901-492-4921
Is Sole Proprietor?:No
Enumeration Date:2012-09-17
Last Update Date:2012-12-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN169428363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner