Provider Demographics
NPI:1740170067
Name:OHNSTAD, GRACE LINDA MIMMACK
Entity type:Individual
Prefix:
First Name:GRACE
Middle Name:LINDA MIMMACK
Last Name:OHNSTAD
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2175 JUDGE FRAN JAMIESON WAY APT 307
Mailing Address - Street 2:
Mailing Address - City:MELBOURNE
Mailing Address - State:FL
Mailing Address - Zip Code:32940-6177
Mailing Address - Country:US
Mailing Address - Phone:720-224-2116
Mailing Address - Fax:
Practice Address - Street 1:1405 S ORANGE AVE STE 500
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32806-2153
Practice Address - Country:US
Practice Address - Phone:305-899-3230
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-07-08
Last Update Date:2025-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLRN9635023163WC0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WC0200XNursing Service ProvidersRegistered NurseCritical Care Medicine