Provider Demographics
NPI:1609315670
Name:GRUE, TINA (NP-C)
Entity Type:Individual
Prefix:
First Name:TINA
Middle Name:
Last Name:GRUE
Suffix:
Gender:F
Credentials:NP-C
Other - Prefix:
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Mailing Address - Street 1:3158 FREEDOM DR STE 3102
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28208-0014
Mailing Address - Country:US
Mailing Address - Phone:704-332-0396
Mailing Address - Fax:704-971-0035
Practice Address - Street 1:7903 PROVIDENCE RD STE 110
Practice Address - Street 2:
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28277-8300
Practice Address - Country:US
Practice Address - Phone:704-248-5101
Practice Address - Fax:704-248-5120
Is Sole Proprietor?:No
Enumeration Date:2017-02-23
Last Update Date:2023-10-24
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
NC5009322363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner