1508458688 NPI number — MRS. YOLANDA ANTERNETT GRIMES LPN

Table of content: MRS. YOLANDA ANTERNETT GRIMES LPN (NPI 1508458688)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1508458688 NPI number — MRS. YOLANDA ANTERNETT GRIMES LPN

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
GRIMES
Provider First Name:
YOLANDA
Provider Middle Name:
ANTERNETT
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
LPN
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
GRIMES
Provider Other First Name:
YOLANDA
Provider Other Middle Name:
ANTERNETT
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
LPN
Provider Other Last Name Type Code:
2

NPI Number Information

NPI Number:
1508458688
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
02/09/2021
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
841 PRUDENTIAL DR STE 1241
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
JACKSONVILLE
Provider Business Mailing Address State Name:
FL
Provider Business Mailing Address Postal Code:
32207-8329
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
904-803-8358
Provider Business Mailing Address Fax Number:
888-676-4449

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
841 PRUDENTIAL DR STE 1241
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
JACKSONVILLE
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
32207-8329
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
904-803-8358
Provider Business Practice Location Address Fax Number:
888-676-4449
Provider Enumeration Date:
02/09/2021

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 164W00000X , with the licence number:  PN5185376 , registered in the state of FL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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