Provider Demographics
NPI:1467904466
Name:GROBMAN, TANYA ALICIA (ARNP)
Entity Type:Individual
Prefix:
First Name:TANYA
Middle Name:ALICIA
Last Name:GROBMAN
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 1:3470 NE 17TH WAY
Mailing Address - Street 2:
Mailing Address - City:OAKLAND PARK
Mailing Address - State:FL
Mailing Address - Zip Code:33334-5386
Mailing Address - Country:US
Mailing Address - Phone:954-816-6263
Mailing Address - Fax:
Practice Address - Street 1:3001 CORAL HILLS DR
Practice Address - Street 2:SUITE 360
Practice Address - City:CORAL SPRINGS
Practice Address - State:FL
Practice Address - Zip Code:33065-4172
Practice Address - Country:US
Practice Address - Phone:954-341-2916
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-10-26
Last Update Date:2016-10-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL9332048363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily