Provider Demographics
NPI:1114110228
Name:GRUNBAUM, KRISTIN HEDDEN (ARNP)
Entity Type:Individual
Prefix:
First Name:KRISTIN
Middle Name:HEDDEN
Last Name:GRUNBAUM
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 1:500 UNIVERSITY BLVD STE 116
Mailing Address - Street 2:
Mailing Address - City:JUPITER
Mailing Address - State:FL
Mailing Address - Zip Code:33458-2774
Mailing Address - Country:US
Mailing Address - Phone:561-627-4377
Mailing Address - Fax:561-627-6496
Practice Address - Street 1:500 UNIVERSITY BLVD STE 116
Practice Address - Street 2:
Practice Address - City:JUPITER
Practice Address - State:FL
Practice Address - Zip Code:33458-2774
Practice Address - Country:US
Practice Address - Phone:561-627-4377
Practice Address - Fax:561-627-6496
Is Sole Proprietor?:No
Enumeration Date:2007-08-22
Last Update Date:2012-03-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLARNP9212289363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily