Provider Demographics
NPI:1629794300
Name:GRUBBS, TERI (FNP)
Entity Type:Individual
Prefix:
First Name:TERI
Middle Name:
Last Name:GRUBBS
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:119 EAGLE CREEK RANCH BLVD
Mailing Address - Street 2:
Mailing Address - City:FLORESVILLE
Mailing Address - State:TX
Mailing Address - Zip Code:78114-9237
Mailing Address - Country:US
Mailing Address - Phone:210-247-8032
Mailing Address - Fax:
Practice Address - Street 1:1105 OAK ST STE A
Practice Address - Street 2:
Practice Address - City:JOURDANTON
Practice Address - State:TX
Practice Address - Zip Code:78026-2117
Practice Address - Country:US
Practice Address - Phone:210-247-8032
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-10-14
Last Update Date:2023-04-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX703110163W00000X
TX1112308363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No163W00000XNursing Service ProvidersRegistered Nurse