Healthcare Provider Details

I. General information

NPI: 1659837078
Provider Name (Legal Business Name): LINDSEY ANN GRYCH APRN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/11/2019
Last Update Date: 04/21/2020
Certification Date: 04/21/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1514 1ST ST N
WINTER HAVEN FL
33881-2476
US

IV. Provider business mailing address

47 5TH ST NW
WINTER HAVEN FL
33881-4672
US

V. Phone/Fax

Practice location:
  • Phone: 866-234-8534
  • Fax:
Mailing address:
  • Phone: 862-229-7970
  • Fax: 863-837-4469

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAPRN11000673
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: