Provider Demographics
NPI:1194884049
Name:GRINDE, KATHLEEN ANN (ARNP)
Entity type:Individual
Prefix:
First Name:KATHLEEN
Middle Name:ANN
Last Name:GRINDE
Suffix:
Gender:F
Credentials:ARNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8946 FOUNDERS CIR
Mailing Address - Street 2:
Mailing Address - City:PALMETTO
Mailing Address - State:FL
Mailing Address - Zip Code:34221-1307
Mailing Address - Country:US
Mailing Address - Phone:727-741-4692
Mailing Address - Fax:
Practice Address - Street 1:8946 FOUNDERS CIR
Practice Address - Street 2:
Practice Address - City:PALMETTO
Practice Address - State:FL
Practice Address - Zip Code:34221-1307
Practice Address - Country:US
Practice Address - Phone:727-741-4692
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-12-07
Last Update Date:2013-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL2697732363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLP29974Medicare UPIN