Provider Demographics
NPI:1891720538
Name:GRANDGENETT, HELENA B (CRNA)
Entity Type:Individual
Prefix:
First Name:HELENA
Middle Name:B
Last Name:GRANDGENETT
Suffix:
Gender:F
Credentials:CRNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4485 FURLING LN
Mailing Address - Street 2:
Mailing Address - City:DESTIN
Mailing Address - State:FL
Mailing Address - Zip Code:32541-5331
Mailing Address - Country:US
Mailing Address - Phone:850-650-7606
Mailing Address - Fax:850-337-1698
Practice Address - Street 1:4485 FURLING LN
Practice Address - Street 2:
Practice Address - City:DESTIN
Practice Address - State:FL
Practice Address - Zip Code:32541-5331
Practice Address - Country:US
Practice Address - Phone:850-650-7606
Practice Address - Fax:850-337-1698
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-11
Last Update Date:2018-08-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLARNP9168155367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLG2796OtherBCBS
FL303110108Medicaid
FLE4226DMedicare ID - Type Unspecified