Provider Demographics
NPI:1922309178
Name:GROSSMAN, TRUDY CHERI (FNP-BC)
Entity Type:Individual
Prefix:
First Name:TRUDY
Middle Name:CHERI
Last Name:GROSSMAN
Suffix:
Gender:F
Credentials:FNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12899 WALSINGHAM RD
Mailing Address - Street 2:
Mailing Address - City:LARGO
Mailing Address - State:FL
Mailing Address - Zip Code:33774-3537
Mailing Address - Country:US
Mailing Address - Phone:727-596-9490
Mailing Address - Fax:813-635-7943
Practice Address - Street 1:12899 WALSINGHAM RD
Practice Address - Street 2:
Practice Address - City:LARGO
Practice Address - State:FL
Practice Address - Zip Code:33774-3537
Practice Address - Country:US
Practice Address - Phone:727-596-9490
Practice Address - Fax:813-635-7943
Is Sole Proprietor?:No
Enumeration Date:2010-11-04
Last Update Date:2023-06-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAPRN9227290363LP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP2300XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPrimary Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL113514600Medicaid