Provider Demographics
NPI:1558734178
Name:GRIGOL, YEKATERINA (PA)
Entity Type:Individual
Prefix:
First Name:YEKATERINA
Middle Name:
Last Name:GRIGOL
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:6605 HILLWAY CIR
Mailing Address - Street 2:STE 101
Mailing Address - City:NAPLES
Mailing Address - State:FL
Mailing Address - Zip Code:34112-8754
Mailing Address - Country:US
Mailing Address - Phone:786-239-3066
Mailing Address - Fax:
Practice Address - Street 1:140 SW 84TH AVE
Practice Address - Street 2:SUITE B
Practice Address - City:PLANTATION
Practice Address - State:FL
Practice Address - Zip Code:33324-2736
Practice Address - Country:US
Practice Address - Phone:954-476-2338
Practice Address - Fax:954-933-8539
Is Sole Proprietor?:No
Enumeration Date:2015-11-04
Last Update Date:2021-06-03
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
FLPA9109386363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant