Provider Demographics
NPI:1619206745
Name:AKINPETIDE, GRACE (CRNP-PMH)
Entity type:Individual
Prefix:
First Name:GRACE
Middle Name:
Last Name:AKINPETIDE
Suffix:
Gender:F
Credentials:CRNP-PMH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1400 MERCANTILE LN STE 242
Mailing Address - Street 2:
Mailing Address - City:LARGO
Mailing Address - State:MD
Mailing Address - Zip Code:20774-5353
Mailing Address - Country:US
Mailing Address - Phone:301-381-2320
Mailing Address - Fax:
Practice Address - Street 1:1400 MERCANTILE LN STE 242
Practice Address - Street 2:
Practice Address - City:LARGO
Practice Address - State:MD
Practice Address - Zip Code:20774-5353
Practice Address - Country:US
Practice Address - Phone:301-381-2320
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-12-20
Last Update Date:2024-10-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0024168530363LF0000X
MDR170998363LF0000X, 363LP0808X
DCRN1006812363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily