Healthcare Provider Details

I. General information

NPI: 1639809742
Provider Name (Legal Business Name): GARRET GROSS PA-C
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/13/2022
Last Update Date: 06/13/2022
Certification Date: 06/13/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2842 SE FEDERAL HWY
STUART FL
34994-5738
US

IV. Provider business mailing address

2842 SE FEDERAL HWY
STUART FL
34994-5738
US

V. Phone/Fax

Practice location:
  • Phone: 184-473-3377
  • Fax: 844-752-8300
Mailing address:
  • Phone: 844-733-3774
  • Fax: 844-752-8300

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberPA9116012
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: