Provider Demographics
NPI:1851871024
Name:GRANT, SHAKHIA (APRN)
Entity Type:Individual
Prefix:MRS
First Name:SHAKHIA
Middle Name:
Last Name:GRANT
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3636 UNIVERSITY BLVD S STE B2
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32216-4223
Mailing Address - Country:US
Mailing Address - Phone:844-808-9096
Mailing Address - Fax:904-638-8752
Practice Address - Street 1:3636 UNIVERSITY BLVD S STE B
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32216-4223
Practice Address - Country:US
Practice Address - Phone:844-808-9096
Practice Address - Fax:904-638-8752
Is Sole Proprietor?:Yes
Enumeration Date:2018-08-17
Last Update Date:2020-05-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLARNP9254135363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health