Provider Demographics
NPI:1629074398
Name:GRUBB, DONALD MICHAEL (ARNP)
Entity Type:Individual
Prefix:
First Name:DONALD
Middle Name:MICHAEL
Last Name:GRUBB
Suffix:
Gender:M
Credentials:ARNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10612 OUT ISLAND DR
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33615-2519
Mailing Address - Country:US
Mailing Address - Phone:813-855-4759
Mailing Address - Fax:
Practice Address - Street 1:2323 CURLEW RD
Practice Address - Street 2:STE 2A
Practice Address - City:DUNEDIN
Practice Address - State:FL
Practice Address - Zip Code:34698-9331
Practice Address - Country:US
Practice Address - Phone:727-781-3480
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-06-27
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLARNP1344742363LA2200X, 363LX0106X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
Not Answered363LX0106XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerOccupational Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLS48877Medicare UPIN
FLY3936Medicare ID - Type Unspecified