Healthcare Provider Details

I. General information

NPI: 1629865399
Provider Name (Legal Business Name): JESSICA GRYBKO RCCS, RSC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/24/2025
Last Update Date: 04/24/2025
Certification Date: 04/24/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

92 W MILLER ST
ORLANDO FL
32806-2032
US

IV. Provider business mailing address

10131 N COUNTRY CLUB WAY
CITRUS SPRINGS FL
34434-3512
US

V. Phone/Fax

Practice location:
  • Phone: 352-875-2694
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code246W00000X
TaxonomyCardiology Technician
License Number00131588
License Number StateFL
# 2
Primary TaxonomyY
Taxonomy Code246XS1301X
TaxonomySonography Specialist/Technologist Cardiovascular
License Number00131588
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: