Provider Demographics
NPI:1356886733
Name:GRANGAARD, PETER BLAKE (PA)
Entity type:Individual
Prefix:
First Name:PETER
Middle Name:BLAKE
Last Name:GRANGAARD
Suffix:
Gender:M
Credentials:PA
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Mailing Address - Street 1:1945 VERSAILLES ST
Mailing Address - Street 2:
Mailing Address - City:SARASOTA
Mailing Address - State:FL
Mailing Address - Zip Code:34239-6900
Mailing Address - Country:US
Mailing Address - Phone:941-365-0770
Mailing Address - Fax:833-974-1480
Practice Address - Street 1:1945 VERSAILLES ST
Practice Address - Street 2:
Practice Address - City:SARASOTA
Practice Address - State:FL
Practice Address - Zip Code:34239-6900
Practice Address - Country:US
Practice Address - Phone:941-365-0770
Practice Address - Fax:833-974-1480
Is Sole Proprietor?:No
Enumeration Date:2016-12-21
Last Update Date:2025-10-15
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
MN12277363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant