Individual ProviderStacey GrantNurse PractitionerPhysician Assistants & Advanced Practice Nursing ProvidersPractice Address2702 S Orange Ave # 5216, Orlando, FL 32806-5402(407) 254-5545(407) 254-5074PECOS EnrollmentBased on the most recent information from CMS, provider Stacey Grant does not have current enrollment records in PECOS.Part BMedicare Part BNot EnrolledHHAHome Health AgencyNot EnrolledDMEDurable Medical EquipmentNot EnrolledPMDPower Mobility DeviceNot EnrolledCMS last updated its PECOS records 2 days ago.Profile DetailsProvider ID1033833769Provider TypeIndividualFull NameGrant, StaceyGenderFemaleSole ProprietorNoEnumeration Date9/27/2022Last Updated10/17/2022Contact InformationPractice LocationPractice Address2702 S Orange Ave # 5216, Orlando, FL 32806-5402Phone(407) 254-5545Fax(407) 254-5545Mailing LocationMailing Address2702 S Orange Ave # 5216, Orlando, FL 32806-5402Phone(407) 254-5074FaxUnlisted FaxProvider TaxonomiesCodeDescriptionLicenseCode363LF0000XPrimaryDescriptionNurse PractitionerPhysician Assistants & Advanced Practice Nursing ProvidersLicense11022037Florida