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General NPI Number Information
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NPI Number | 1376320788
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Entity Type | Individual
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Provider Name | ANGELA GRIMBERG PA
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Gender | Female
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Dates
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Enumeration Date | 09/11/2023
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Last Update Date | 05/29/2024
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Provider Practice Location Address
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Address Line | 6535 NEMOURS PKWY
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City | ORLANDO
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State | FL
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Zip | 32827-7884
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Country | US
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Telephone | 407-650-7000
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Fax |
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Provider Business Mailing Address
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Address Line | 6560 SAND LAKE SOUND RD UNIT 6417
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City | ORLANDO
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State | FL
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Zip | 32819-7656
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Country | US
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Telephone | 727-433-4226
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363AM0700X
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Taxonomy Name | Medical Physician Assistant
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 208M00000X
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Taxonomy Name | Hospitalist Physician
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License Number | PA9117907
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License Number State | FL
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