Provider Demographics
NPI:1669179248
Name:GROSSEIBL, DEIDRA (RN)
Entity type:Individual
Prefix:MS
First Name:DEIDRA
Middle Name:
Last Name:GROSSEIBL
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:DEIDRA
Other - Middle Name:
Other - Last Name:BROWN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:101 S OLD COACHMAN RD APT 505
Mailing Address - Street 2:
Mailing Address - City:CLEARWATER
Mailing Address - State:FL
Mailing Address - Zip Code:33765-4428
Mailing Address - Country:US
Mailing Address - Phone:321-831-0410
Mailing Address - Fax:
Practice Address - Street 1:148 13TH ST SW # 200
Practice Address - Street 2:
Practice Address - City:LARGO
Practice Address - State:FL
Practice Address - Zip Code:33770-3127
Practice Address - Country:US
Practice Address - Phone:727-450-3030
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-02-14
Last Update Date:2023-02-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL9587483163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse