Provider Demographics
NPI:1437117165
Name:GRONBERG-CAREY, TIANA DENISE (ACNP)
Entity Type:Individual
Prefix:MS
First Name:TIANA
Middle Name:DENISE
Last Name:GRONBERG-CAREY
Suffix:
Gender:F
Credentials:ACNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:17189 INTERSTATE 45 S STE 475
Mailing Address - Street 2:
Mailing Address - City:SHENANDOAH
Mailing Address - State:TX
Mailing Address - Zip Code:77385-3320
Mailing Address - Country:US
Mailing Address - Phone:936-270-3933
Mailing Address - Fax:713-791-5134
Practice Address - Street 1:17189 INTERSTATE 45 S STE 475
Practice Address - Street 2:
Practice Address - City:SHENANDOAH
Practice Address - State:TX
Practice Address - Zip Code:77385-3320
Practice Address - Country:US
Practice Address - Phone:936-270-3933
Practice Address - Fax:713-791-5134
Is Sole Proprietor?:No
Enumeration Date:2006-05-03
Last Update Date:2024-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXAP113279363LA2100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXP00433610OtherRR MEDICARE
TX178584201Medicaid
TX8Y0066OtherBCBS
TX8G1727Medicare PIN
TXQ57335Medicare UPIN
TX178584201Medicaid