Provider Demographics
NPI:1750468807
Name:GRUBE, TINA M (CRNP)
Entity Type:Individual
Prefix:
First Name:TINA
Middle Name:M
Last Name:GRUBE
Suffix:
Gender:F
Credentials:CRNP
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Mailing Address - Street 1:924 COLONIAL AVE
Mailing Address - Street 2:BLDG E
Mailing Address - City:YORK
Mailing Address - State:PA
Mailing Address - Zip Code:17403-3450
Mailing Address - Country:US
Mailing Address - Phone:717-843-9089
Mailing Address - Fax:717-843-6075
Practice Address - Street 1:924 COLONIAL AVE
Practice Address - Street 2:BLDG E
Practice Address - City:YORK
Practice Address - State:PA
Practice Address - Zip Code:17403-3450
Practice Address - Country:US
Practice Address - Phone:717-843-9089
Practice Address - Fax:717-843-6075
Is Sole Proprietor?:No
Enumeration Date:2006-11-01
Last Update Date:2013-05-16
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
MDR100739363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
P39918Medicare UPIN