Healthcare Provider Details

I. General information

NPI: 1881995140
Provider Name (Legal Business Name): AMY LYN GROBSTICK ARNP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/03/2010
Last Update Date: 05/16/2026
Certification Date: 05/16/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

868 SHORELINE CIR
PONTE VEDRA BEACH FL
32082-2741
US

IV. Provider business mailing address

868 SHORELINE CIR
PONTE VEDRA BEACH FL
32082-2741
US

V. Phone/Fax

Practice location:
  • Phone: 904-866-9551
  • Fax: 904-542-7346
Mailing address:
  • Phone: 904-866-9551
  • Fax: 570-554-8214

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208VP0014X
TaxonomyInterventional Pain Medicine Physician
License NumberAPRN9315700
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberA114736
License Number StateIA
# 3
Primary TaxonomyN
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number9315700
License Number StateFL
# 4
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberAPRN9315700
License Number StateFL
# 5
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number4704320850
License Number StateMI
# 6
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberARNP9315700
License Number StateFL
# 7
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number9315700
License Number StateFL
# 8
Primary TaxonomyN
Taxonomy Code363LP2300X
TaxonomyPrimary Care Nurse Practitioner
License NumberARNP9315700
License Number StateFL
# 9
Primary TaxonomyN
Taxonomy Code2084N0400X
TaxonomyNeurology Physician
License NumberAPRN9315700
License Number StateFL
# 10
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number9315700
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: