Provider Demographics
NPI:1598314247
Name:GROVER, TAWNYA
Entity Type:Individual
Prefix:
First Name:TAWNYA
Middle Name:
Last Name:GROVER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6546 E INGRAM ST
Mailing Address - Street 2:
Mailing Address - City:MESA
Mailing Address - State:AZ
Mailing Address - Zip Code:85205-3785
Mailing Address - Country:US
Mailing Address - Phone:480-201-5143
Mailing Address - Fax:
Practice Address - Street 1:6546 E INGRAM ST
Practice Address - Street 2:
Practice Address - City:MESA
Practice Address - State:AZ
Practice Address - Zip Code:85205-3785
Practice Address - Country:US
Practice Address - Phone:480-201-5143
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-09-05
Last Update Date:2019-09-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ231477363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ231477OtherAZ BOARD OF NURSING