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General NPI Number Information
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NPI Number | 1417766734
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Entity Type | Individual
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Provider Name | ANDREA VANEGAS GRILLO NP
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Gender | Female
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Dates
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Enumeration Date | 01/01/2025
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Last Update Date | 01/01/2025
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Provider Practice Location Address
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Address Line | 4889 LAKE WORTH RD STE 109
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City | GREENACRES
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State | FL
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Zip | 33463-3480
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Country | US
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Telephone | 617-649-7532
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Fax | 561-649-7532
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Provider Business Mailing Address
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Address Line | 9314 FOREST HILL BLVD # 124
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City | WELLINGTON
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State | FL
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Zip | 33411-6577
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Country | US
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Telephone | 718-791-8641
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | APRN11035284
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License Number State | FL
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