Healthcare Provider Details

I. General information

NPI: 1811926033
Provider Name (Legal Business Name): CHESTER JOHN GRABOWSKI JR. ARNP
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/01/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5767 49TH ST N
ST PETERSBURG FL
33709-2107
US

IV. Provider business mailing address

5767 49TH ST N
ST PETERSBURG FL
33709-2107
US

V. Phone/Fax

Practice location:
  • Phone: 727-522-0558
  • Fax: 727-521-3605
Mailing address:
  • Phone: 727-522-0558
  • Fax: 727-521-3605

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberARNP 3390602
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: