MEDICARE: YANICK GRIBKOFF APRN

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	APRN2153222	FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1912960188
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	YANICK GRIBKOFF APRN

Provider Business Mailing Address
First Line	:	1150 45TH ST
Second Line	:
City	:	WEST PALM BEACH
State	:	FL
Zip	:	33407-2361
Country	:	US
Telephone Number	:	561-514-5300
Fax Number	:	561-837-5332

Provider Business Practice Location Address
First Line	:	1150 45TH ST
Second Line	:
City	:	WEST PALM BEACH
State	:	FL
Zip	:	33407-2361
Country	:	US
Telephone Number	:	561-514-5459
Fax Number	:	561-514-5540

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

Provider Enumeration Date	:	04/10/2006
Last Update Date	:	07/21/2021

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