Provider Demographics
NPI:1578037560
Name:GRONES, GLENDA KATHERINE (PHD, FNP-C, APRN)
Entity Type:Individual
Prefix:DR
First Name:GLENDA
Middle Name:KATHERINE
Last Name:GRONES
Suffix:
Gender:F
Credentials:PHD, FNP-C, APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2669 SPRUCE CREEK BLVD
Mailing Address - Street 2:
Mailing Address - City:PORT ORANGE
Mailing Address - State:FL
Mailing Address - Zip Code:32128-6893
Mailing Address - Country:US
Mailing Address - Phone:386-852-2461
Mailing Address - Fax:
Practice Address - Street 1:2669 SPRUCE CREEK BLVD
Practice Address - Street 2:
Practice Address - City:PORT ORANGE
Practice Address - State:FL
Practice Address - Zip Code:32128-6893
Practice Address - Country:US
Practice Address - Phone:386-852-2461
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-01-14
Last Update Date:2021-09-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL11000800363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL11000800OtherAPRN