Provider Demographics
NPI:1033900386
Name:GROSSE, KRISTY MICHELLE
Entity type:Individual
Prefix:
First Name:KRISTY
Middle Name:MICHELLE
Last Name:GROSSE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5693 GAMBLE RD
Mailing Address - Street 2:
Mailing Address - City:MONTICELLO
Mailing Address - State:FL
Mailing Address - Zip Code:32344-3615
Mailing Address - Country:US
Mailing Address - Phone:251-656-1565
Mailing Address - Fax:
Practice Address - Street 1:5693 GAMBLE RD
Practice Address - Street 2:
Practice Address - City:MONTICELLO
Practice Address - State:FL
Practice Address - Zip Code:32344-3615
Practice Address - Country:US
Practice Address - Phone:251-656-1565
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-05-15
Last Update Date:2025-05-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant