Doctor Name: | CLAY GRIMES |
NPI Number: | 1245636471 |
Entity Type Code: | Individual (1) |
Gender: | M |
Credentials: | AG-ACNP |
License Number: | ARNP9349258 |
Business Practice Address: | 564 Redberry Ln Saint Johns, FL - 322594807 |
Business Phone Number: | 9048068262 |
Business Fax Number: | |
Mailing Address: | 564 Redberry Ln, SAINT JOHNS |
State: | FL |
Postal Code: | 322594807 |
Phone Number: | 9048068262 |
Fax Number: | |
NPI Enumeration Date: | 11/17/2014 |
NPI Last Update Date: | 11/17/2014 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 363LA2100X |
License Number: | ARNP9349258 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | FL |
Taxonomy Type: | Physician Assistants & Advanced Practice Nursing Providers |
Taxonomy Classification: | Nurse Practitioner |
Taxonomy Specialization: | Acute Care |
Taxonomy Definition: |