Healthcare Provider Details

I. General information

NPI: 1669179248
Provider Name (Legal Business Name): DEIDRA GROSSEIBL FNP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: DEIDRA BROWN

II. Dates (important events)

Enumeration Date: 02/14/2023
Last Update Date: 05/08/2026
Certification Date: 05/08/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1575 SANTA BARBARA BLVD
THE VILLAGES FL
32159-6820
US

IV. Provider business mailing address

1020 LAKE SUMTER LNDG
THE VILLAGES FL
32162-2699
US

V. Phone/Fax

Practice location:
  • Phone: 352-674-1740
  • Fax:
Mailing address:
  • Phone: 352-674-8905
  • Fax: 352-674-8919

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAPRN11047168
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: