Provider Demographics
NPI:1669655445
Name:GRASSO, L KATHERINE (PA-C)
Entity Type:Individual
Prefix:MRS
First Name:L
Middle Name:KATHERINE
Last Name:GRASSO
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:MRS
Other - First Name:KATHERINE
Other - Middle Name:REYNA
Other - Last Name:GRASSO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA-C
Mailing Address - Street 1:PO BOX 100287
Mailing Address - Street 2:
Mailing Address - City:GAINESVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32610-0287
Mailing Address - Country:US
Mailing Address - Phone:352-265-0916
Mailing Address - Fax:
Practice Address - Street 1:1600 SW ARCHER RD
Practice Address - Street 2:
Practice Address - City:GAINESVILLE
Practice Address - State:FL
Practice Address - Zip Code:32610-3003
Practice Address - Country:US
Practice Address - Phone:352-265-0916
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-12-14
Last Update Date:2016-12-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA357429363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant