| Doctor Name: | WANDA M GRANT |
| NPI Number: | 1003192014 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | RN |
| License Number: | 2130982 |
| Business Practice Address: | 1800 Mercy Dr Suite 302 Orlando, FL - 328085646 |
| Business Phone Number: | 4078753700 |
| Business Fax Number: | 4075224671 |
| Mailing Address: | 1800 Mercy Dr, Suite 302 ORLANDO |
| State: | FL |
| Postal Code: | 328085646 |
| Phone Number: | 4078753700 |
| Fax Number: | 4075224671 |
| NPI Enumeration Date: | 10/24/2011 |
| NPI Last Update Date: | 10/24/2011 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 163WP0808X |
| License Number: | 2130982 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | FL |
| Taxonomy Type: | Nursing Service Providers |
| Taxonomy Classification: | Registered Nurse |
| Taxonomy Specialization: | Psych/Mental Health |
| Taxonomy Definition: | |