Provider Demographics
NPI: | 1861673733 |
---|---|
Name: | GRUBER, CAROL L (WHNP) |
Entity Type: | Individual |
Prefix: | |
First Name: | CAROL |
Middle Name: | L |
Last Name: | GRUBER |
Suffix: | |
Gender: | F |
Credentials: | WHNP |
Other - Prefix: | |
Other - First Name: | |
Other - Middle Name: | |
Other - Last Name: | |
Other - Suffix: | |
Other - Last Name Type: | |
Other - Credentials: | |
Mailing Address - Street 1: | 2675 WINKLER AVE FL 2 |
Mailing Address - Street 2: | |
Mailing Address - City: | FORT MYERS |
Mailing Address - State: | FL |
Mailing Address - Zip Code: | 33901-9342 |
Mailing Address - Country: | US |
Mailing Address - Phone: | 877-856-3774 |
Mailing Address - Fax: | |
Practice Address - Street 1: | 1132 S 14TH ST |
Practice Address - Street 2: | |
Practice Address - City: | FERNANDINA BEACH |
Practice Address - State: | FL |
Practice Address - Zip Code: | 32034-2920 |
Practice Address - Country: | US |
Practice Address - Phone: | 904-432-3061 |
Practice Address - Fax: | 904-432-3062 |
Is Sole Proprietor?: | No |
Enumeration Date: | 2007-11-20 |
Last Update Date: | 2023-06-09 |
Deactivation Date: | |
Deactivation Code: | |
Reactivation Date: |
Provider Licenses
State | License ID | Taxonomies |
---|---|---|
FL | APRN9496660 | 363LF0000X, 363LG0600X |
Provider Taxonomies
Primary? | Code | Type | Classification | Specialization |
---|---|---|---|---|
Yes | 363LG0600X | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Gerontology |
No | 363LF0000X | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Family |
Provider Identifiers
State | Identifier ID | ID Type | Issuer |
---|---|---|---|
FL | L0889 | Other | MEDICARE |
FL | F4PB8 | Other | BCBS |