Provider Demographics
NPI:1013386929
Name:GROCE, JUSTIN (APRN)
Entity Type:Individual
Prefix:
First Name:JUSTIN
Middle Name:
Last Name:GROCE
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 1:115 WINWOOD DR
Mailing Address - Street 2:SUITE 105
Mailing Address - City:LEBANON
Mailing Address - State:TN
Mailing Address - Zip Code:37087-1340
Mailing Address - Country:US
Mailing Address - Phone:615-444-4126
Mailing Address - Fax:855-785-2890
Practice Address - Street 1:115 WINWOOD DR
Practice Address - Street 2:SUITE 105
Practice Address - City:LEBANON
Practice Address - State:TN
Practice Address - Zip Code:37087-1340
Practice Address - Country:US
Practice Address - Phone:615-444-4126
Practice Address - Fax:855-785-2890
Is Sole Proprietor?:No
Enumeration Date:2015-09-21
Last Update Date:2017-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN20598363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN6060213OtherBCBS OF TN
TNP01697499OtherR/R MEDICARE
TNQ021233Medicaid
TN3306523OtherUNITED HEALTHCARE
TN620842749OtherHUMANA
TN620842749OtherHUMANA