MEDICARE: CARMEN CORNELIA ELISABETH GRUIA FNP

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	APRN.CNP.024213	OH
2	363LF0000X	Family Nurse Practitioner	11031206	FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	APRN.CNP.024213	OTHER	OH	OHIO BOARD OF NURSING

General Provider Information

NPI Number	:	1548726755
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CARMEN CORNELIA ELISABETH GRUIA FNP

Provider Business Mailing Address
First Line	:	888 DAYTON ST STE 200
Second Line	:
City	:	YELLOW SPRINGS
State	:	OH
Zip	:	45387-1777
Country	:	US
Telephone Number	:	937-767-7291
Fax Number	:	937-767-1302

Provider Business Practice Location Address
First Line	:	3030 E SEMORAN BLVD STE 264
Second Line	:
City	:	APOPKA
State	:	FL
Zip	:	32703-5953
Country	:	US
Telephone Number	:	321-280-3810
Fax Number	:

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

Provider Enumeration Date	:	02/12/2019
Last Update Date	:	07/23/2024

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