Provider Demographics
NPI:1154591279
Name:MINI CLINIC OF VERO BEACH LLC
Entity type:Organization
Organization Name:MINI CLINIC OF VERO BEACH LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ARNP BUSINESS OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:PATRICIA
Authorized Official - Middle Name:ANN
Authorized Official - Last Name:GRENZENBACH
Authorized Official - Suffix:
Authorized Official - Credentials:ARNP
Authorized Official - Phone:772-567-0033
Mailing Address - Street 1:777 37TH ST
Mailing Address - Street 2:SUITE B103
Mailing Address - City:VERO BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32960-4873
Mailing Address - Country:US
Mailing Address - Phone:772-567-0033
Mailing Address - Fax:772-567-1714
Practice Address - Street 1:777 37TH ST
Practice Address - Street 2:SUITE B103
Practice Address - City:VERO BEACH
Practice Address - State:FL
Practice Address - Zip Code:32960-4873
Practice Address - Country:US
Practice Address - Phone:772-567-0033
Practice Address - Fax:772-567-1714
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-03-04
Last Update Date:2012-02-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL3396072261QP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care