MEDICARE: MADELINE GRANT PA-C

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	363A00000X	Physician Assistant

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	:	1326763921
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MADELINE GRANT PA-C

Provider Business Mailing Address
First Line	:	1844 WISTERIA ST
Second Line	:
City	:	SARASOTA
State	:	FL
Zip	:	34239-3826
Country	:	US
Telephone Number	:	803-257-7938
Fax Number	:

Provider Business Practice Location Address
First Line	:	836 SUNSET LAKE BLVD STE 101
Second Line	:
City	:	VENICE
State	:	FL
Zip	:	34292-7555
Country	:	US
Telephone Number	:	941-408-0500
Fax Number	:	941-496-8558

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

Provider Enumeration Date	:	10/05/2022
Last Update Date	:	04/14/2026

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Directions to “ MADELINE GRANT PA-C” Practice Location

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