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Organization
GRACEVILLE FAMILY MEDICINE INC
Active
Organization
GRACEVILLE FAMILY MEDICINE INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
LUCINDA W COLLINS ARNP (OWNER)
(850) 360-4909
Entity
Organization
Contact information
Practice address
5239 BROWN ST, GRACEVILLE, FL 32440-2513
(850) 360-4909
(850) 360-4911
Mailing address
5239 BROWN ST, GRACEVILLE, FL 32440-2513
(850) 360-4909
(850) 360-4911
Taxonomy
Speciality
Code
Description
License number
State
363LF0000X
Family Nurse Practitioner
Primary
9321958
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
13075500
—
FL
01
—
51051874
BC/BS OF ALABAMA
AL
01
—
Y0042
BLUE CROSS
FL
01
—
Y0042V
BLUE CROSS BLUE SHIELD
FL
Enumeration date
01/03/2012
Last updated
10/14/2016
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