Provider Demographics
NPI:1487035184
Name:GRIVAS, LINDA (ANP)
Entity Type:Individual
Prefix:MRS
First Name:LINDA
Middle Name:
Last Name:GRIVAS
Suffix:
Gender:F
Credentials:ANP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:66 PARKSIDE DR N
Mailing Address - Street 2:
Mailing Address - City:LEVITTOWN
Mailing Address - State:NY
Mailing Address - Zip Code:11756-1528
Mailing Address - Country:US
Mailing Address - Phone:516-906-6147
Mailing Address - Fax:
Practice Address - Street 1:66 PARKSIDE DR N
Practice Address - Street 2:
Practice Address - City:LEVITTOWN
Practice Address - State:NY
Practice Address - Zip Code:11756-1528
Practice Address - Country:US
Practice Address - Phone:516-906-6147
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-06-18
Last Update Date:2015-06-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY305168163W00000X
NYF305168-1163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse