Provider Demographics
NPI:1912751108
Name:GRANT, VANESSA MARIE
Entity Type:Individual
Prefix:
First Name:VANESSA
Middle Name:MARIE
Last Name:GRANT
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11732 ALBATROSS LN
Mailing Address - Street 2:
Mailing Address - City:RIVERVIEW
Mailing Address - State:FL
Mailing Address - Zip Code:33569-6300
Mailing Address - Country:US
Mailing Address - Phone:813-420-0219
Mailing Address - Fax:
Practice Address - Street 1:11732 ALBATROSS LN
Practice Address - Street 2:
Practice Address - City:RIVERVIEW
Practice Address - State:FL
Practice Address - Zip Code:33569-6300
Practice Address - Country:US
Practice Address - Phone:813-420-0219
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-04-15
Last Update Date:2024-04-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes374U00000XNursing Service Related ProvidersHome Health AideGroup - Single Specialty