Provider Demographics
NPI:1689847527
Name:GRECO, JOSEPH F (PHD, PA/C)
Entity Type:Individual
Prefix:
First Name:JOSEPH
Middle Name:F
Last Name:GRECO
Suffix:
Gender:M
Credentials:PHD, PA/C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3023 EASTLAND BLVD
Mailing Address - Street 2:SUITE 113
Mailing Address - City:CLEARWATER
Mailing Address - State:FL
Mailing Address - Zip Code:33761-4106
Mailing Address - Country:US
Mailing Address - Phone:727-791-3830
Mailing Address - Fax:727-791-3629
Practice Address - Street 1:3023 EASTLAND BLVD
Practice Address - Street 2:SUITE 113
Practice Address - City:CLEARWATER
Practice Address - State:FL
Practice Address - Zip Code:33761-4106
Practice Address - Country:US
Practice Address - Phone:727-791-3830
Practice Address - Fax:727-791-3629
Is Sole Proprietor?:Yes
Enumeration Date:2008-04-11
Last Update Date:2008-04-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPA 0257363AS0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical