Provider Demographics
NPI:1235298936
Name:GROSZCZYK, JOY KAREN (PA)
Entity Type:Individual
Prefix:MS
First Name:JOY
Middle Name:KAREN
Last Name:GROSZCZYK
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1625 SE 3RD AVE
Mailing Address - Street 2:SUITE 400
Mailing Address - City:FORT LAUDERDALE
Mailing Address - State:FL
Mailing Address - Zip Code:33316-2521
Mailing Address - Country:US
Mailing Address - Phone:954-832-0055
Mailing Address - Fax:954-832-0063
Practice Address - Street 1:1625 SE 3RD AVE
Practice Address - Street 2:SUITE 400
Practice Address - City:FORT LAUDERDALE
Practice Address - State:FL
Practice Address - Zip Code:33316-2521
Practice Address - Country:US
Practice Address - Phone:954-832-0055
Practice Address - Fax:954-832-0063
Is Sole Proprietor?:No
Enumeration Date:2006-12-08
Last Update Date:2009-05-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPA9103072363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLQ30080Medicare UPIN
FLU3871ZMedicare ID - Type Unspecified