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General NPI Number Information
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NPI Number | 1609414143
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Entity Type | Individual
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Provider Name | AMBER GRIMM PA-C
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Gender | Female
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Dates
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Enumeration Date | 12/16/2019
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Last Update Date | 01/12/2024
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Provider Practice Location Address
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Address Line | 1337 S INTERNATIONAL PKWY STE 1301
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City | LAKE MARY
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State | FL
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Zip | 32746-1402
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Country | US
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Telephone | 407-878-0022
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Fax |
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Provider Business Mailing Address
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Address Line | 1337 S INTERNATIONAL PKWY STE 100
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City | LAKE MARY
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State | FL
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Zip | 32746-1402
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Country | US
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Telephone | 407-878-0022
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Fax | 888-815-1039
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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 | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number | PA9112838
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License Number State | FL
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