Healthcare Provider Details

I. General information

NPI: 1356947949
Provider Name (Legal Business Name): TAYLER GRYBOWSKI
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/08/2020
Last Update Date: 12/08/2020
Certification Date: 12/08/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

615 VONDERBURG DR
BRANDON FL
33511-5972
US

IV. Provider business mailing address

615 VONDERBURG DR
BRANDON FL
33511-5972
US

V. Phone/Fax

Practice location:
  • Phone: 813-684-2663
  • Fax: 813-658-6222
Mailing address:
  • Phone: 813-684-2663
  • Fax: 813-658-6222

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: