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

Gracevine Healthcare Svcs a Professnal Nursing Corp

Organization Family Nurse Practitioner · NPI 1255050084

Gracevine Healthcare Svcs a Professnal Nursing Corp is a Family Nurse Practitioner in San Bernardino, California. Registered with an NPI since 2022.

In the registry since
2022
What do these letters mean?
Corp — Corporation
A form of business registration, not a clinical qualification.

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Practice location Address checks out

473 E Carnegie Dr Ste 200
San Bernardino, CA 92408-4201
Phone: (909) 743-1300
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Pin is approximate — placed at the ZIP-code centre, not the exact door.

Specialties & licences

Family Nurse Practitioner (primary) Taxonomy 363LF0000X

Record details

NPI number1255050084
Entity typeOrganization (Type 2)
Organization subpartNo
Authorized official Oluwayemisi Daramola — Owner · (909) 743-1300
NPI enumeratedAugust 24, 2022
Last updated in NPPESMay 27, 2025
Certification dateMay 27, 2025
Mailing address473 E Carnegie Dr, Ste 200, San Bernardino, CA 92408

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