Basic Information
| Provider Information | |||||||||
| NPI: | 1013434570 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | GRIMES | ||||||||
| FirstName: | BRITTANY | ||||||||
| MiddleName: | NICOLE | ||||||||
| NamePrefix: | |||||||||
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| Credential: | FNP-C | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1717 N E ST STE 331 | ||||||||
| Address2: | |||||||||
| City: | PENSACOLA | ||||||||
| State: | FL | ||||||||
| PostalCode: | 325016335 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8504441772 | ||||||||
| FaxNumber: | 8504441755 | ||||||||
| Practice Location | |||||||||
| Address1: | 1717 N E ST STE 331 | ||||||||
| Address2: | |||||||||
| City: | PENSACOLA | ||||||||
| State: | FL | ||||||||
| PostalCode: | 325016335 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8504846500 | ||||||||
| FaxNumber: | 8508571747 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/25/2017 | ||||||||
| LastUpdateDate: | 05/12/2022 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
| IsOrganizationSubpart: | |||||||||
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| AuthorizedOfficialCredential: | |||||||||
| NPICertificationDate: | 05/12/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363L00000X | APRN-9322736 | FL | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner |
ID Information
| ID | Type | State | Issuer | Description | NZ902 | 01 | FL | MEDICARE - FL | OTHER | 22573100 | 05 | FL | MEDICAID | EI8WT | 01 | FL | BCBS FL | OTHER |