Provider Demographics
NPI:1346261203
Name:GRANNUM, SONIA CECILIA (ARNP)
Entity Type:Individual
Prefix:MRS
First Name:SONIA
Middle Name:CECILIA
Last Name:GRANNUM
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 1:18950 SW 12TH ST
Mailing Address - Street 2:
Mailing Address - City:PEMBROKE PINES
Mailing Address - State:FL
Mailing Address - Zip Code:33029-6019
Mailing Address - Country:US
Mailing Address - Phone:954-437-0720
Mailing Address - Fax:954-433-9372
Practice Address - Street 1:1611 NW 12TH AVE
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33136-1005
Practice Address - Country:US
Practice Address - Phone:305-585-6602
Practice Address - Fax:305-585-0037
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-23
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLARNP966912163WX0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WX0200XNursing Service ProvidersRegistered NurseOncology