Basic Information
| Provider Information | |||||||||
| NPI: | 1649860461 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | GRANDE | ||||||||
| FirstName: | NICOLE | ||||||||
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| Mailing Information | |||||||||
| Address1: | 90 EDGEWATER DR APT 911 | ||||||||
| Address2: | |||||||||
| City: | CORAL GABLES | ||||||||
| State: | FL | ||||||||
| PostalCode: | 331336919 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3058075233 | ||||||||
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| Practice Location | |||||||||
| Address1: | 6200 SW 73RD ST | ||||||||
| Address2: | |||||||||
| City: | SOUTH MIAMI | ||||||||
| State: | FL | ||||||||
| PostalCode: | 331434679 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7866624000 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 01/25/2021 | ||||||||
| LastUpdateDate: | 01/27/2021 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 01/27/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207L00000X | 11011102 | FL | Y | Allopathic & Osteopathic Physicians | Anesthesiology |
No ID Information.