Provider Demographics
NPI:1104303403
Name:GRGIC, MARIJA (FNP)
Entity type:Individual
Prefix:
First Name:MARIJA
Middle Name:
Last Name:GRGIC
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2105 SANTE FE CIR
Mailing Address - Street 2:
Mailing Address - City:ARNOLD
Mailing Address - State:MO
Mailing Address - Zip Code:63010-5215
Mailing Address - Country:US
Mailing Address - Phone:314-602-9242
Mailing Address - Fax:
Practice Address - Street 1:2105 SANTE FE CIR
Practice Address - Street 2:
Practice Address - City:ARNOLD
Practice Address - State:MO
Practice Address - Zip Code:63010-5215
Practice Address - Country:US
Practice Address - Phone:314-602-9242
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-07-19
Last Update Date:2018-07-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2018022115363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily