MEDICARE: MS. SUSAN SOLOMON-GRIMES ARNP

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363LF0000X	Family Nurse Practitioner	771582	FL

General Provider Information

NPI Number	:	1083692511
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. SUSAN SOLOMON-GRIMES ARNP

Provider Business Mailing Address
First Line	:	13475 SOUTHERN BLVD
Second Line	:	STE 100
City	:	LOXAHATCHEE
State	:	FL
Zip	:	33470-9203
Country	:	US
Telephone Number	:	561-231-5200
Fax Number	:

Provider Business Practice Location Address
First Line	:	8200 JOG RD
Second Line	:	SUITE 102
City	:	BOYNTON BEACH
State	:	FL
Zip	:	33472-2981
Country	:	US
Telephone Number	:	561-734-7400
Fax Number	:	561-734-7448

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/05/2006
Last Update Date	:	04/05/2017

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