Provider Demographics
NPI:1447459797
Name:GRIMM, ROBIN ANN (NP-C)
Entity type:Individual
Prefix:MRS
First Name:ROBIN
Middle Name:ANN
Last Name:GRIMM
Suffix:
Gender:F
Credentials:NP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:525 MICHELIN RD
Mailing Address - Street 2:
Mailing Address - City:GREENVILLE
Mailing Address - State:SC
Mailing Address - Zip Code:29605-6131
Mailing Address - Country:US
Mailing Address - Phone:864-458-1376
Mailing Address - Fax:864-458-1382
Practice Address - Street 1:525 MICHELIN RD
Practice Address - Street 2:
Practice Address - City:GREENVILLE
Practice Address - State:SC
Practice Address - Zip Code:29605-6131
Practice Address - Country:US
Practice Address - Phone:864-458-1376
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-07-17
Last Update Date:2018-07-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SCF3206363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC1447459797Medicare NSC