Basic Information
| Provider Information | |||||||||
| NPI: | 1962148627 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | GRINNELL | ||||||||
| FirstName: | NIKKOL | ||||||||
| MiddleName: | FERRIS | ||||||||
| NamePrefix: | MRS. | ||||||||
| NameSuffix: | |||||||||
| Credential: | APRN | ||||||||
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| Mailing Information | |||||||||
| Address1: | 7458 PINE FOREST RD | ||||||||
| Address2: | |||||||||
| City: | PENSACOLA | ||||||||
| State: | FL | ||||||||
| PostalCode: | 325268818 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8504944600 | ||||||||
| FaxNumber: | 8509410084 | ||||||||
| Practice Location | |||||||||
| Address1: | 7458 PINE FOREST RD | ||||||||
| Address2: | |||||||||
| City: | PENSACOLA | ||||||||
| State: | FL | ||||||||
| PostalCode: | 325268818 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8504944600 | ||||||||
| FaxNumber: | 8509410084 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/06/2022 | ||||||||
| LastUpdateDate: | 08/23/2022 | ||||||||
| NPIDeactivationReasonCode: | |||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
| IsOrganizationSubpart: | |||||||||
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| NPICertificationDate: | 08/23/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363LF0000X | 11018309 | FL | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Family |
No ID Information.