Provider Demographics
NPI:1083498398
Name:ANDRADE, GRACE (PA)
Entity Type:Individual
Prefix:
First Name:GRACE
Middle Name:
Last Name:ANDRADE
Suffix:
Gender:F
Credentials:PA
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Mailing Address - Street 1:17000 PORTER RD STE 205
Mailing Address - Street 2:
Mailing Address - City:WINTER GARDEN
Mailing Address - State:FL
Mailing Address - Zip Code:34787-8915
Mailing Address - Country:US
Mailing Address - Phone:132-184-1644
Mailing Address - Fax:321-841-7727
Practice Address - Street 1:17000 PORTER RD STE 205
Practice Address - Street 2:
Practice Address - City:WINTER GARDEN
Practice Address - State:FL
Practice Address - Zip Code:34787-8915
Practice Address - Country:US
Practice Address - Phone:321-843-5851
Practice Address - Fax:321-841-7727
Is Sole Proprietor?:No
Enumeration Date:2023-08-21
Last Update Date:2023-12-05
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
FLPAT9117921207XS0106X
FLPA9117921363AS0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical
No207XS0106XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryHand Surgery