Individual
TANISHA GRANT
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
PMHNP-C
Contact information
Practice address
37177 NORTH AVE, DADE CITY, FL 33523
(678) 973-8470
Mailing address
38345 LAKE AVE, DADE CITY, FL 33525-4414
(352) 467-2935
Taxonomy
Speciality
Code
Description
License number
State
163WG0000X
General Practice Registered Nurse
RN9457208
FL
363LP0808X
Psychiatric/Mental Health Nurse Practitioner
Primary
APRN11041866
FL
Other
Enumeration date
11/03/2021
Last updated
08/25/2025
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