Individual
JACLYN MARIE GRAVIS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
FNP
Contact information
Practice address
2 MEDICAL PARK RD, SUITE 501, COLUMBIA, SC 29203-6808
(803) 434-3320
(803) 540-1011
Mailing address
300 E MCBEE AVE FL 4, GREENVILLE, SC 29601-2842
(864) 522-8603
Taxonomy
Speciality
Code
Description
License number
State
363LF0000X
Family Nurse Practitioner
Primary
20386
SC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
NP4147
—
SC
Enumeration date
08/02/2016
Last updated
07/19/2023
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