Provider Demographics
NPI:1992595284
Name:GRIMBERG, ASHLEY TAYLOR (FNP-BC)
Entity type:Individual
Prefix:
First Name:ASHLEY
Middle Name:TAYLOR
Last Name:GRIMBERG
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 1:5204 N HELTON RD
Mailing Address - Street 2:
Mailing Address - City:WINSTON
Mailing Address - State:GA
Mailing Address - Zip Code:30187-1124
Mailing Address - Country:US
Mailing Address - Phone:470-513-1147
Mailing Address - Fax:
Practice Address - Street 1:5204 N HELTON RD
Practice Address - Street 2:
Practice Address - City:WINSTON
Practice Address - State:GA
Practice Address - Zip Code:30187-1124
Practice Address - Country:US
Practice Address - Phone:470-513-1147
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-05-09
Last Update Date:2025-05-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN291998363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily