Provider Demographics
NPI:1578264578
Name:GRANT, JAMIE LYNN (APRN)
Entity type:Individual
Prefix:
First Name:JAMIE
Middle Name:LYNN
Last Name:GRANT
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 44008
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32231-4008
Mailing Address - Country:US
Mailing Address - Phone:912-729-6821
Mailing Address - Fax:912-729-7594
Practice Address - Street 1:201 LAKESHORE PT
Practice Address - Street 2:
Practice Address - City:SAINT MARYS
Practice Address - State:GA
Practice Address - Zip Code:31558-3890
Practice Address - Country:US
Practice Address - Phone:912-729-6821
Practice Address - Fax:912-729-7594
Is Sole Proprietor?:No
Enumeration Date:2023-03-15
Last Update Date:2024-09-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN331484363L00000X
FLAPRN11024258363LF0000X, 363L00000X
FL11024258363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily