Provider Demographics
NPI:1821643214
Name:GRIER, CONSANDIA A
Entity Type:Individual
Prefix:
First Name:CONSANDIA
Middle Name:A
Last Name:GRIER
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:PO BOX 525
Mailing Address - Street 2:
Mailing Address - City:LOWELL
Mailing Address - State:FL
Mailing Address - Zip Code:32663-0525
Mailing Address - Country:US
Mailing Address - Phone:352-355-6204
Mailing Address - Fax:
Practice Address - Street 1:15211 NW 29TH TER
Practice Address - Street 2:
Practice Address - City:REDDICK
Practice Address - State:FL
Practice Address - Zip Code:32686
Practice Address - Country:US
Practice Address - Phone:352-355-6204
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-08-03
Last Update Date:2019-08-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL372600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes372600000XNursing Service Related ProvidersAdult Companion