Provider Demographics
NPI:1457710949
Name:GRAY, NATASHA ANNE (PA-C)
Entity Type:Individual
Prefix:MRS
First Name:NATASHA
Middle Name:ANNE
Last Name:GRAY
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:MRS
Other - First Name:NATALIE
Other - Middle Name:
Other - Last Name:GRAY
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:11945 SAN JOSE BLVD STE 300
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32223-1627
Mailing Address - Country:US
Mailing Address - Phone:904-396-1725
Mailing Address - Fax:904-396-4893
Practice Address - Street 1:1836 FLORIDA AVE
Practice Address - Street 2:
Practice Address - City:PANAMA CITY
Practice Address - State:FL
Practice Address - Zip Code:32405-4639
Practice Address - Country:US
Practice Address - Phone:850-872-8510
Practice Address - Fax:850-872-7412
Is Sole Proprietor?:No
Enumeration Date:2016-02-12
Last Update Date:2020-02-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPA9109251363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant