Healthcare Provider Details

I. General information

NPI: 1295348654
Provider Name (Legal Business Name): IVAN GRENIER ARNP
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/26/2020
Last Update Date: 05/21/2025
Certification Date: 05/21/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5673 SW 137TH AVE
MIAMI FL
33183-1101
US

IV. Provider business mailing address

14104 SW 42ND TER
MIAMI FL
33175-3644
US

V. Phone/Fax

Practice location:
  • Phone: 305-385-3949
  • Fax:
Mailing address:
  • Phone: 786-587-4549
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAPRN11008772
License Number StateFL
# 2
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License NumberAPRN11008772
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: