Individual
MARY CATHERINE GRISSOM
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
APRN
Contact information
Practice address
1115 E RIDGEWOOD ST, ORLANDO, FL 32803-5443
(407) 841-1100
Mailing address
326 N MILLS AVE, ORLANDO, FL 32803-5734
(407) 841-1100
Taxonomy
Speciality
Code
Description
License number
State
363LA2100X
Acute Care Nurse Practitioner
Primary
APRN11009353
FL
363LG0600X
Gerontology Nurse Practitioner
APRN11009353
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
112792700
—
FL
Enumeration date
11/02/2020
Last updated
08/08/2024
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