Provider Demographics
NPI:1689855264
Name:GREINER, VIRGINIA MARY (ARNP)
Entity Type:Individual
Prefix:MRS
First Name:VIRGINIA
Middle Name:MARY
Last Name:GREINER
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 1:935 LEW BLVD
Mailing Address - Street 2:
Mailing Address - City:ST AUGUSTINE
Mailing Address - State:FL
Mailing Address - Zip Code:32080-5462
Mailing Address - Country:US
Mailing Address - Phone:904-814-6968
Mailing Address - Fax:904-824-0564
Practice Address - Street 1:9889 GATE PKWY N STE 305
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32246-9230
Practice Address - Country:US
Practice Address - Phone:904-725-6463
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-11-23
Last Update Date:2024-02-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLARNP 9181473363LP0808X
FLARNP 918 1473363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLHR894ZMedicare PIN