Grimes, Theresa

Grimes, Theresa is an individual health care provider with primary practice located at 75 N Country Rd , Port Jefferson NY 11777-2119. She recently has only one registered license in Physician Assistants & Advanced Practice Nursing Providers / Family, which is considered as her primary health care specialty. Grimes, Theresa can be contacted via phone (631) 476-2847.

Contact Information

Primary practice address
75 N Country Rd Port Jefferson NY 11777-2119
Phone: (631) 476-2847
Fax:
Website:
Map and Directions

Health care specialties

SpecialtyCodeLicense #State
Physician Assistants & Advanced Practice Nursing Providers / Family 363LF0000X F332400-1 New York

Profile Details

NPI number 1912910910
LBN Legal business name Grimes, Theresa
Credentials FNP-BC
Entity Individual
Sole proprietor 1 No
Enumeration date Aug 14th, 2006
Last updated Feb 4th, 2011 - about 15 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

Request for update

Identifiers

StateTypeNumberIssuer
All States NPI 1912910910 NPPES
New York MEDICAID 01993700

Popular Providers