MEDICARE: ESTRAICA GRAYSON APRN

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	363LA2100X	Acute Care Nurse Practitioner	APRN9363698	FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1851865471
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ESTRAICA GRAYSON APRN

Provider Business Mailing Address
First Line	:	PO BOX 917770
Second Line	:
City	:	ORLANDO
State	:	FL
Zip	:	32891-0001
Country	:	US
Telephone Number	:	813-974-2201
Fax Number	:	813-974-4325

Provider Business Practice Location Address
First Line	:	5 TAMPA GENERAL CIR STE 820
Second Line	:
City	:	TAMPA
State	:	FL
Zip	:	33606-3658
Country	:	US
Telephone Number	:	813-844-4935
Fax Number	:

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

Provider Enumeration Date	:	01/16/2019
Last Update Date	:	03/22/2021

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