Provider Demographics
NPI:1104894294
Name:GRINOLD, CARY (FNP,CDE)
Entity type:Individual
Prefix:
First Name:CARY
Middle Name:
Last Name:GRINOLD
Suffix:
Gender:M
Credentials:FNP,CDE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:881 USS JAMES MADISON ROAD
Mailing Address - Street 2:NAVAL AMBULATORY CARE CENTER
Mailing Address - City:KINGS BAY
Mailing Address - State:GA
Mailing Address - Zip Code:31547
Mailing Address - Country:US
Mailing Address - Phone:912-573-6583
Mailing Address - Fax:
Practice Address - Street 1:881 USS JAMES MADISON ROAD
Practice Address - Street 2:NAVAL AMBULATORY CARE CENTER
Practice Address - City:KINGS BAY
Practice Address - State:GA
Practice Address - Zip Code:31547
Practice Address - Country:US
Practice Address - Phone:912-573-6583
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-03-14
Last Update Date:2011-02-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMR22890363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily