MEDICARE: MISS EMILY A GRISNIK 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	363AM0700X	Medical Physician Assistant	C06145	MD

General Provider Information

NPI Number	:	1144679416
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MISS EMILY A GRISNIK PA-C

Provider Business Mailing Address
First Line	:	151 SOUTHHALLL LANE
Second Line	:	STE 300
City	:	MAITLAND
State	:	FL
Zip	:	32751
Country	:	US
Telephone Number	:	407-875-2080
Fax Number	:

Provider Business Practice Location Address
First Line	:	26840 POINT LOOKOUT RD
Second Line	:
City	:	LEONARDTOWN
State	:	MD
Zip	:	20650-1409
Country	:	US
Telephone Number	:	301-475-8091
Fax Number	:	301-475-6712

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

Provider Enumeration Date	:	06/08/2016
Last Update Date	:	05/30/2019

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Directions to “ MISS EMILY A GRISNIK PA-C” Practice Location

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