Provider Demographics
NPI:1356327175
Name:GRINER, BRENDA SHUBERT (ARNP)
Entity Type:Individual
Prefix:
First Name:BRENDA
Middle Name:SHUBERT
Last Name:GRINER
Suffix:
Gender:F
Credentials:ARNP
Other - Prefix:
Other - First Name:BRENDA
Other - Middle Name:SHUBERT
Other - Last Name:WEINSTEIN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:ARNP
Mailing Address - Street 1:111 SE 8TH AVE
Mailing Address - Street 2:APT 802
Mailing Address - City:FT LAUDERDALE
Mailing Address - State:FL
Mailing Address - Zip Code:33301-2031
Mailing Address - Country:US
Mailing Address - Phone:954-325-5947
Mailing Address - Fax:
Practice Address - Street 1:1600 S ANDREWS AVE
Practice Address - Street 2:
Practice Address - City:FT LAUDERDALE
Practice Address - State:FL
Practice Address - Zip Code:33316-2510
Practice Address - Country:US
Practice Address - Phone:954-325-5947
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-12-22
Last Update Date:2011-06-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLARNP1572602363LN0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LN0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerNeonatal
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL300846100Medicaid