Provider Demographics
NPI:1134660152
Name:FLORES, GRISSEL (NP-C)
Entity Type:Individual
Prefix:
First Name:GRISSEL
Middle Name:
Last Name:FLORES
Suffix:
Gender:F
Credentials:NP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1 FITZGERALD AVE
Mailing Address - Street 2:
Mailing Address - City:CLIFTON
Mailing Address - State:NJ
Mailing Address - Zip Code:07011-3402
Mailing Address - Country:US
Mailing Address - Phone:732-643-8289
Mailing Address - Fax:
Practice Address - Street 1:1020 MAIN ST STE C
Practice Address - Street 2:
Practice Address - City:PATERSON
Practice Address - State:NJ
Practice Address - Zip Code:07503-2244
Practice Address - Country:US
Practice Address - Phone:862-336-1200
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-03-09
Last Update Date:2018-11-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ26NR16692300390200000X
NJ26NJ00875100363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ26NJ00875100OtherNJ FNP LICENSE