Provider Demographics
NPI:1831292770
Name:GRUMBACH, CHERYL LYNN (ARNP)
Entity Type:Individual
Prefix:
First Name:CHERYL
Middle Name:LYNN
Last Name:GRUMBACH
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 1:1001 SE MONTEREY COMMONS BLVD
Mailing Address - Street 2:STE 300
Mailing Address - City:STUART
Mailing Address - State:FL
Mailing Address - Zip Code:34996-3329
Mailing Address - Country:US
Mailing Address - Phone:772-286-9400
Mailing Address - Fax:772-283-3832
Practice Address - Street 1:1001 SE MONTEREY COMMONS BLVD
Practice Address - Street 2:STE 300
Practice Address - City:STUART
Practice Address - State:FL
Practice Address - Zip Code:34996-3329
Practice Address - Country:US
Practice Address - Phone:772-286-9400
Practice Address - Fax:772-283-3832
Is Sole Proprietor?:No
Enumeration Date:2006-09-06
Last Update Date:2016-05-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLARNP1429212363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLY7413OtherBCBS-FL
FLP01117824OtherRAILROAD MEDICARE
FL007269000Medicaid
FLY7413OtherBCBS-FL
FLP01117824OtherRAILROAD MEDICARE