MEDICARE: TERI GRUBBS 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	163W00000X	Registered Nurse	703110	TX
2	363LF0000X	Family Nurse Practitioner	1112308	TX

General Provider Information

NPI Number	:	1629794300
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	TERI GRUBBS FNP

Provider Business Mailing Address
First Line	:	119 EAGLE CREEK RANCH BLVD
Second Line	:
City	:	FLORESVILLE
State	:	TX
Zip	:	78114-9237
Country	:	US
Telephone Number	:	210-247-8032
Fax Number	:

Provider Business Practice Location Address
First Line	:	1105 OAK ST STE A
Second Line	:
City	:	JOURDANTON
State	:	TX
Zip	:	78026-2117
Country	:	US
Telephone Number	:	210-247-8032
Fax Number	:

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

Provider Enumeration Date	:	10/14/2022
Last Update Date	:	04/04/2023

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Directions to “ TERI GRUBBS FNP” Practice Location

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