Provider Demographics
NPI:1326787102
Name:GRUBBS, RENEE MARIA (NP-BC)
Entity Type:Individual
Prefix:MRS
First Name:RENEE
Middle Name:MARIA
Last Name:GRUBBS
Suffix:
Gender:F
Credentials:NP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:36725 JOAN DR
Mailing Address - Street 2:
Mailing Address - City:MECHANICSVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:20659-5830
Mailing Address - Country:US
Mailing Address - Phone:850-381-4677
Mailing Address - Fax:
Practice Address - Street 1:36725 JOAN DR
Practice Address - Street 2:
Practice Address - City:MECHANICSVILLE
Practice Address - State:MD
Practice Address - Zip Code:20659-5830
Practice Address - Country:US
Practice Address - Phone:850-381-4677
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-06-01
Last Update Date:2022-06-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDR221660363LA2100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care