Provider Demographics
NPI:1801058052
Name:GRISSO, SHERI SHANNON (ARNP)
Entity type:Individual
Prefix:MS
First Name:SHERI
Middle Name:SHANNON
Last Name:GRISSO
Suffix:
Gender:F
Credentials:ARNP
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:13005 SOUTHERN BLVD STE 122
Mailing Address - Street 2:MEDICAL MALL ONE, SUITE 122
Mailing Address - City:LOXAHATCHEE
Mailing Address - State:FL
Mailing Address - Zip Code:33470-9231
Mailing Address - Country:US
Mailing Address - Phone:561-842-5050
Mailing Address - Fax:561-793-9989
Practice Address - Street 1:13005 SOUTHERN BLVD STE 122
Practice Address - Street 2:MEDICAL MALL ONE, SUITE 122
Practice Address - City:LOXAHATCHEE
Practice Address - State:FL
Practice Address - Zip Code:33470-9231
Practice Address - Country:US
Practice Address - Phone:561-842-5050
Practice Address - Fax:561-793-9989
Is Sole Proprietor?:No
Enumeration Date:2008-06-30
Last Update Date:2011-10-28
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
FLARNP3357122363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLBD969Medicare PIN
FLBD970ZMedicare PIN