Individual
TONYA GRISSAM
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
6451 N FEDERAL HWY STE 800, FORT LAUDERDALE, FL 33308-1409
(800) 586-5022
(954) 229-9801
Mailing address
6451 N FEDERAL HWY STE 800, FORT LAUDERDALE, FL 33308-1409
(800) 586-5022
(954) 229-9801
Taxonomy
Speciality
Code
Description
License number
State
208000000X
Pediatrics Physician
051567
GA
208000000X
Pediatrics Physician
Primary
4301106345
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
000960913D
—
GA
05
—
000960913H
—
GA
05
—
000960913I
—
GA
Enumeration date
11/22/2006
Last updated
01/01/2026
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