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General NPI Number Information
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NPI Number | 1740464304
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Entity Type | Individual
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Provider Name | AMY LEE GRANT PA-C
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Gender | Female
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Dates
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Enumeration Date | 12/19/2007
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Last Update Date | 02/27/2019
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Provider Practice Location Address
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Address Line | 3 SHIRCLIFF WAY STE 200
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City | JACKSONVILLE
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State | FL
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Zip | 32204-4785
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Country | US
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Telephone | 904-384-3699
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Fax | 904-384-8529
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Provider Business Mailing Address
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Address Line | PO BOX 25317
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City | TAMPA
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State | FL
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Zip | 33622-5317
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Country | US
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Telephone | 813-286-0033
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Fax | 813-282-1806
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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 | PA3229
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License Number State | FL
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