Provider Demographics
NPI:1689899734
Name:GRENIER, NICOLE L (MD)
Entity Type:Individual
Prefix:DR
First Name:NICOLE
Middle Name:L
Last Name:GRENIER
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3000 N UNIVERSITY DR
Mailing Address - Street 2:SUITE K
Mailing Address - City:CORAL SPRINGS
Mailing Address - State:FL
Mailing Address - Zip Code:33065-5055
Mailing Address - Country:US
Mailing Address - Phone:954-755-2288
Mailing Address - Fax:
Practice Address - Street 1:3000 N UNIVERSITY DR
Practice Address - Street 2:SUITE K
Practice Address - City:CORAL SPRINGS
Practice Address - State:FL
Practice Address - Zip Code:33065-5055
Practice Address - Country:US
Practice Address - Phone:954-755-2288
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-16
Last Update Date:2010-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RILP00898207N00000X
FLME106744207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL149YMOtherBC/BS
FL149YMOtherBC/BS