# GRACE PEDIATRICS PL

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1326885294
- **Authorized official:** COLLEEN A THOMPSON (APRN, OWNER)
- **Authorized official phone:** (386) 243-8474

## Contact information

- **Practice address:** 238 SW CULLEN AVE, FORT WHITE, FL 32038-3536
- **Practice address phone:** (386) 243-8474
- **Mailing address:** 4196 W US HIGHWAY 90 STE 105, LAKE CITY, FL 32055-8834
- **Mailing address phone:** (386) 243-8474
- **Mailing address fax:** (386) 438-5945

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 261QR1300X | Rural Health Clinic/Center | — | NULL | Yes |

## Other

- **Enumeration date:** 07/09/2024
- **Last updated:** 07/09/2024