Organization
GRACE PEDIATRICS PL
Active
Organization subpart
No
Provider details
NPI number
Authorized official
COLLEEN A THOMPSON (APRN, OWNER)
(386) 243-8474
Entity
Organization
Contact information
Practice address
238 SW CULLEN AVE, FORT WHITE, FL 32038-3536
(386) 243-8474
Mailing address
4196 W US HIGHWAY 90 STE 105, LAKE CITY, FL 32055-8834
(386) 243-8474
(386) 438-5945
Taxonomy
Speciality
Code
Description
License number
State
261QR1300X
Rural Health Clinic/Center
Primary
—
—
Other
Enumeration date
07/09/2024
Last updated
07/09/2024
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