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NPI Code Detail

MEDICARE: CELESTE HEBRA GRANDE

MEDICARE: CELESTE HEBRA GRANDE
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
1363A00000XPhysician AssistantPA9121190FL

General Provider Information

NPI Number : 1285528653
Entity Type Code : Individual
Provider Name (Legal Business Name) : CELESTE HEBRA GRANDE
Provider Business Mailing Address
First Line : PO BOX 947407
Second Line :
City : ATLANTA
State : GA
Zip : 30394-7407
Country : US
Telephone Number : 941-917-2600
Fax Number : 941-917-7884
Provider Business Practice Location Address
First Line : 1950 ARLINGTON ST STE 101
Second Line :
City : SARASOTA
State : FL
Zip : 34239-3508
Country : US
Telephone Number : 941-917-3400
Fax Number : 941-917-4300
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/09/2025
Last Update Date : 02/04/2026

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Directions to “ CELESTE HEBRA GRANDE ” Practice Location

Language Start Address Practice Location
These directions are for planning purposes only. You may find that construction projects, traffic, or other events may cause road conditions to differ from the map results.

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