MEDICARE: MRS. NADYNE FLOYD GRUBBS LCSW

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	1041C0700X	Clinical Social Worker	SW13300	FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	SW13300	OTHER	FL	STATE OF FLORIDA DEPARTMENT OF HEALTH DIVISION OF MEDICAL QUALITY

General Provider Information

NPI Number	:	1760794564
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. NADYNE FLOYD GRUBBS LCSW

Provider Business Mailing Address
First Line	:	17665 NW 22ND AVE
Second Line	:
City	:	MIAMI GARDENS
State	:	FL
Zip	:	33056-4731
Country	:	US
Telephone Number	:	305-591-0731
Fax Number	:

Provider Business Practice Location Address
First Line	:	7272 W OAKLAND PARK BLVD
Second Line	:
City	:	LAUDERHILL
State	:	FL
Zip	:	33313-1041
Country	:	US
Telephone Number	:	954-578-8399
Fax Number	:

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

Provider Enumeration Date	:	07/08/2010
Last Update Date	:	07/08/2010

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