Provider Demographics
NPI:1689096216
Name:GRAU, MARILUCY (ARNP)
Entity Type:Individual
Prefix:MS
First Name:MARILUCY
Middle Name:
Last Name:GRAU
Suffix:
Gender:F
Credentials:ARNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:121 S ORANGE AVE STE 940
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32801-3234
Mailing Address - Country:US
Mailing Address - Phone:407-658-9687
Mailing Address - Fax:407-286-4515
Practice Address - Street 1:1502 VILLAGE OAK LN
Practice Address - Street 2:
Practice Address - City:KISSIMMEE
Practice Address - State:FL
Practice Address - Zip Code:34746-6592
Practice Address - Country:US
Practice Address - Phone:407-205-3588
Practice Address - Fax:407-978-6757
Is Sole Proprietor?:No
Enumeration Date:2014-01-16
Last Update Date:2018-11-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL9193606363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLF0114050OtherAMERICAN ACADEMY OF NURSE PRACTITIONERS CERTIFICATION PROGRAM