Healthcare Provider Details

I. General information

NPI: 1679381966
Provider Name (Legal Business Name): AVALON KAREN GRANTHAM APRN, FNP-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: AVALON KAREN GOLDWASSER RN

II. Dates (important events)

Enumeration Date: 12/19/2024
Last Update Date: 03/13/2025
Certification Date: 03/13/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2950 CLEVELAND CLINIC BLVD
WESTON FL
33331-3609
US

IV. Provider business mailing address

17773 MAPLEWOOD DR
BOCA RATON FL
33487-2172
US

V. Phone/Fax

Practice location:
  • Phone: 954-659-2000
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163WX0200X
TaxonomyOncology Registered Nurse
License NumberRN9515506
License Number StateFL
# 2
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAPRN11038028
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: