Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 363LC1500X | Nurse Practitioner - Community Health | 320008 | NY |
Y | 363LF0000X | Nurse Practitioner - Family Medicine | 11002278 | FL |
NPI | 1336192525 |
---|---|
Provider Name | Suzanne Marie Gromniak |
First Address | Davie, FL 33328-6102 |
Second Address | Cooper City, FL 33330-2312 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 18/05/2006 |
Last Update Date | 13/09/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
01777751 | (05) | NY |
S42201 | (02) |