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General NPI Number Information
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NPI Number | 1154591279
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Entity Type | Organization
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Legal Business Name | MINI CLINIC OF VERO BEACH LLC
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Dates
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Enumeration Date | 03/04/2008
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Last Update Date | 02/01/2012
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Provider Practice Location Address
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Address Line | 777 37TH ST SUITE B103
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City | VERO BEACH
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State | FL
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Zip | 32960-4873
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Country | US
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Telephone | 772-567-0033
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Fax | 772-567-1714
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Provider Business Mailing Address
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Address Line | 777 37TH ST SUITE B103
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City | VERO BEACH
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State | FL
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Zip | 32960-4873
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Country | US
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Telephone | 772-567-0033
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Fax | 772-567-1714
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Authorized Official
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Title or Position | ARNP BUSINESS OWNER
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Name | MRS. PATRICIA ANN GRENZENBACH
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Credential | ARNP
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Telephone | 772-567-0033
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QP2300X
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Taxonomy Name | Primary Care Clinic/Center
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License Number | 3396072
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License Number State | FL
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