Provider Demographics
NPI:1912099771
Name:MCCUEN, LAURIE GRISSMAN (ARNP)
Entity type:Individual
Prefix:DR
First Name:LAURIE
Middle Name:GRISSMAN
Last Name:MCCUEN
Suffix:
Gender:F
Credentials:ARNP
Other - Prefix:DR
Other - First Name:LAURIE
Other - Middle Name:LAST
Other - Last Name:GRISSMAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:ARNP, DNP
Mailing Address - Street 1:938 SW MARTIN DOWNS BLVD
Mailing Address - Street 2:
Mailing Address - City:PALM CITY
Mailing Address - State:FL
Mailing Address - Zip Code:34990-2816
Mailing Address - Country:US
Mailing Address - Phone:772-221-7620
Mailing Address - Fax:772-221-9903
Practice Address - Street 1:938 SW MARTIN DOWNS BLVD
Practice Address - Street 2:
Practice Address - City:PALM CITY
Practice Address - State:FL
Practice Address - Zip Code:34990-2816
Practice Address - Country:US
Practice Address - Phone:772-221-7620
Practice Address - Fax:772-221-9903
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-29
Last Update Date:2018-09-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLARNP3104732363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
P97874Medicare ID - Type Unspecified
U1315ZMedicare UPIN