Provider Demographics
NPI:1063732402
Name:GROS, JUDITH ELAINE (NP)
Entity type:Individual
Prefix:
First Name:JUDITH
Middle Name:ELAINE
Last Name:GROS
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 748
Mailing Address - Street 2:
Mailing Address - City:SAN MARCOS
Mailing Address - State:TX
Mailing Address - Zip Code:78667-0748
Mailing Address - Country:US
Mailing Address - Phone:512-392-1161
Mailing Address - Fax:512-392-3530
Practice Address - Street 1:101 UHLAND RD
Practice Address - Street 2:SUITE 107
Practice Address - City:SAN MARCOS
Practice Address - State:TX
Practice Address - Zip Code:78666-6630
Practice Address - Country:US
Practice Address - Phone:512-392-1161
Practice Address - Fax:512-392-3530
Is Sole Proprietor?:No
Enumeration Date:2010-06-08
Last Update Date:2010-06-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX249146363LX0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LX0001XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
P30703Medicare UPIN