Provider records sourced from NPPES (CMS National Plan & Provider Enumeration System). Data current as of August 10, 2026.

Grace Pediatrics Pl

Organization Pediatric Nurse Practitioner · NPI 1720362429

Grace Pediatrics Pl is a Pediatric Nurse Practitioner in Lake City, Florida. Licensed in Florida. Registered with an NPI since 2011.

Licensed in
FL
In the registry since
2011
Specialties on file
2

Practice location Address checks out

4196 W US Highway 90 Ste 105
Lake City, FL 32055-8834
Phone: (386) 243-8474
Fax: (386) 438-5945
Show map & directions

Pin is approximate — placed at the ZIP-code centre, not the exact door.

Specialties & licences

Pediatric Nurse Practitioner (primary) Taxonomy 363LP0200X · Licence 2667852 (FL)
Pediatric Nurse Practitioner Taxonomy 363LP0200X · Licence 9220069 (FL)

Record details

NPI number1720362429
Entity typeOrganization (Type 2)
Organization subpartNo
Authorized official Colleen Thompson — Manager/Arnp/Co-Owner · (386) 243-8474
NPI enumeratedSeptember 29, 2011
Last updated in NPPESFebruary 19, 2014
Mailing address4196 W Us Highway 90, Suite 105, Lake City, FL 32055-8834

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