Provider Demographics
NPI:1992597645
Name:GRANT, KRYSTAL (APRN)
Entity type:Individual
Prefix:
First Name:KRYSTAL
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 1:5936 GRANT ST
Mailing Address - Street 2:
Mailing Address - City:HOLLYWOOD
Mailing Address - State:FL
Mailing Address - Zip Code:33021-5163
Mailing Address - Country:US
Mailing Address - Phone:954-654-1320
Mailing Address - Fax:
Practice Address - Street 1:8001 MARKETPLACE DR STE A
Practice Address - Street 2:
Practice Address - City:OAK RIDGE
Practice Address - State:NC
Practice Address - Zip Code:27310-9302
Practice Address - Country:US
Practice Address - Phone:336-656-2705
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-05-20
Last Update Date:2025-05-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC5022189363LF0000X
FL11039297363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily