MEDICARE: GRACE ROBERTS PA-C

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363A00000X	Physician Assistant

General Provider Information

NPI Number	:	1134980386
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	GRACE ROBERTS PA-C

Provider Business Mailing Address
First Line	:	2708 W SAINT ISABEL ST
Second Line	:
City	:	TAMPA
State	:	FL
Zip	:	33607-6320
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	2708 W SAINT ISABEL ST
Second Line	:
City	:	TAMPA
State	:	FL
Zip	:	33607-6320
Country	:	US
Telephone Number	:	813-877-7434
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/16/2024
Last Update Date	:	05/19/2026

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Directions to “ GRACE ROBERTS PA-C” Practice Location

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