Healthcare Provider Details

I. General information

NPI: 1689096216
Provider Name (Legal Business Name): MARILUCY GRAU ARNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/16/2014
Last Update Date: 11/05/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1502 VILLAGE OAK LN
KISSIMMEE FL
34746-6592
US

IV. Provider business mailing address

121 S ORANGE AVE STE 940
ORLANDO FL
32801-3234
US

V. Phone/Fax

Practice location:
  • Phone: 407-205-3588
  • Fax: 407-978-6757
Mailing address:
  • Phone: 407-658-9687
  • Fax: 407-286-4515

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number9193606
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: