Provider Demographics
NPI:1306817598
Name:POHASKI, GRETCHEN JOY (PA C)
Entity Type:Individual
Prefix:
First Name:GRETCHEN
Middle Name:JOY
Last Name:POHASKI
Suffix:
Gender:F
Credentials:PA C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1720 S ORANGE AVE
Mailing Address - Street 2:SUITE 500
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32806-2945
Mailing Address - Country:US
Mailing Address - Phone:407-426-9693
Mailing Address - Fax:407-426-9694
Practice Address - Street 1:1720 S ORANGE AVE
Practice Address - Street 2:SUITE 500
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32806-2945
Practice Address - Country:US
Practice Address - Phone:407-426-9693
Practice Address - Fax:407-426-9694
Is Sole Proprietor?:No
Enumeration Date:2006-01-27
Last Update Date:2012-07-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NVPA820363A00000X
FLPA9106519363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
NV100502414Medicaid
NV100507300OtherMEDICAID
Q07640Medicare UPIN
NV100507300OtherMEDICAID
NV100502414Medicaid