Healthcare Provider Details

I. General information

NPI: 1972933406
Provider Name (Legal Business Name): ERICA GRACE MAYER PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/19/2013
Last Update Date: 09/18/2025
Certification Date: 09/18/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

455 TOLL GATE ROAD ASP BUILDING SUITE PEACH
WARWICK RI
02886-2759
US

IV. Provider business mailing address

PO BOX 863407
ORLANDO FL
32886-3407
US

V. Phone/Fax

Practice location:
  • Phone: 401-681-2858
  • Fax: 401-921-6943
Mailing address:
  • Phone: 941-917-2600
  • Fax: 941-917-7884

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberPA01181
License Number StateRI
# 2
Primary TaxonomyN
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License Number9107953
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: