Provider Demographics
NPI:1295987345
Name:GRIMALDI, ANGELA (PA)
Entity type:Individual
Prefix:
First Name:ANGELA
Middle Name:
Last Name:GRIMALDI
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 1:4001 RAPHUNE HILL RD
Mailing Address - Street 2:
Mailing Address - City:ST THOMAS
Mailing Address - State:VI
Mailing Address - Zip Code:00802-2905
Mailing Address - Country:US
Mailing Address - Phone:340-774-2331
Mailing Address - Fax:
Practice Address - Street 1:4001 RAPHUNE HILL RD
Practice Address - Street 2:
Practice Address - City:ST THOMAS
Practice Address - State:VI
Practice Address - Zip Code:00802-2905
Practice Address - Country:US
Practice Address - Phone:340-774-2331
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-10-21
Last Update Date:2024-11-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL085003337363A00000X
VI113363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL0533210001Medicare NSC