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NPI Code Detail

MEDICARE: GRACE OWENS

MEDICARE: GRACE OWENS
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
1363AS0400XSurgical Physician Assistant

General Provider Information

NPI Number : 1629871546
Entity Type Code : Individual
Provider Name (Legal Business Name) : GRACE OWENS
Provider Business Mailing Address
First Line : 2901 W SWANN AVE
Second Line :
City : TAMPA
State : FL
Zip : 33609-4056
Country : US
Telephone Number : 813-873-6400
Fax Number :
Provider Business Practice Location Address
First Line : 2901 W SWANN AVE
Second Line :
City : TAMPA
State : FL
Zip : 33609-4056
Country : US
Telephone Number : 813-873-6400
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 03/27/2025
Last Update Date : 03/04/2026

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Directions to “ GRACE OWENS ” Practice Location

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