Provider Demographics
NPI:1013320894
Name:CANNON, GRAZIA ANN SORICE (CNP)
Entity Type:Individual
Prefix:
First Name:GRAZIA
Middle Name:ANN SORICE
Last Name:CANNON
Suffix:
Gender:F
Credentials:CNP
Other - Prefix:
Other - First Name:GRAZIA
Other - Middle Name:ANN
Other - Last Name:SORICE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:2620 ELM HILL PIKE
Mailing Address - Street 2:
Mailing Address - City:NASHVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37214-3108
Mailing Address - Country:US
Mailing Address - Phone:615-425-4200
Mailing Address - Fax:
Practice Address - Street 1:3637 S HIGH ST
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43207-4009
Practice Address - Country:US
Practice Address - Phone:614-748-0205
Practice Address - Fax:614-748-0206
Is Sole Proprietor?:No
Enumeration Date:2014-06-09
Last Update Date:2015-12-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHCOA.15970-NP363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily