Basic Information
| Provider Information | |||||||||
| NPI: | 1013386929 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | GROCE | ||||||||
| FirstName: | JUSTIN | ||||||||
| MiddleName: | |||||||||
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| Credential: | APRN | ||||||||
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| Mailing Information | |||||||||
| Address1: | 115 WINWOOD DR | ||||||||
| Address2: | SUITE 105 | ||||||||
| City: | LEBANON | ||||||||
| State: | TN | ||||||||
| PostalCode: | 370871340 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6154444126 | ||||||||
| FaxNumber: | 8557852890 | ||||||||
| Practice Location | |||||||||
| Address1: | 115 WINWOOD DR | ||||||||
| Address2: | SUITE 105 | ||||||||
| City: | LEBANON | ||||||||
| State: | TN | ||||||||
| PostalCode: | 370871340 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6154444126 | ||||||||
| FaxNumber: | 8557852890 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 09/21/2015 | ||||||||
| LastUpdateDate: | 02/13/2017 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363LA2200X | 20598 | TN | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Adult Health |
ID Information
| ID | Type | State | Issuer | Description | 6060213 | 01 | TN | BCBS OF TN | OTHER | P01697499 | 01 | TN | R/R MEDICARE | OTHER | Q021233 | 05 | TN | MEDICAID | 3306523 | 01 | TN | UNITED HEALTHCARE | OTHER | 620842749 | 01 | TN | HUMANA | OTHER |