Provider Demographics
NPI:1942699988
Name:GRUZINSKAS, BETH ANN (FNP-C)
Entity Type:Individual
Prefix:
First Name:BETH
Middle Name:ANN
Last Name:GRUZINSKAS
Suffix:
Gender:F
Credentials:FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7 WOOD PL
Mailing Address - Street 2:
Mailing Address - City:BAY ST LOUIS
Mailing Address - State:MS
Mailing Address - Zip Code:39520-2836
Mailing Address - Country:US
Mailing Address - Phone:228-216-5737
Mailing Address - Fax:
Practice Address - Street 1:1340 BROAD AVE STE 330
Practice Address - Street 2:
Practice Address - City:GULFPORT
Practice Address - State:MS
Practice Address - Zip Code:39501-2464
Practice Address - Country:US
Practice Address - Phone:228-575-1234
Practice Address - Fax:228-867-4828
Is Sole Proprietor?:No
Enumeration Date:2015-01-14
Last Update Date:2020-12-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MSR853237363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily