Provider Demographics
NPI:1932919321
Name:GRANDES, EDUWARD XAVIER (APRN)
Entity type:Individual
Prefix:
First Name:EDUWARD
Middle Name:XAVIER
Last Name:GRANDES
Suffix:
Gender:M
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2151 W HILLSBORO BLVD STE 211
Mailing Address - Street 2:
Mailing Address - City:DEERFIELD BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33442-1275
Mailing Address - Country:US
Mailing Address - Phone:954-694-7292
Mailing Address - Fax:949-864-3367
Practice Address - Street 1:2151 W HILLSBORO BLVD STE 211
Practice Address - Street 2:
Practice Address - City:DEERFIELD BEACH
Practice Address - State:FL
Practice Address - Zip Code:33442-1275
Practice Address - Country:US
Practice Address - Phone:954-694-7292
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-01-09
Last Update Date:2025-11-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL11037062363LP0808X
NYF406990-01363LP0808X
NM83525363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health