Provider Demographics
NPI:1770574337
Name:GRIMALDI, FRANK JR (PA-C, ATC)
Entity type:Individual
Prefix:MR
First Name:FRANK
Middle Name:
Last Name:GRIMALDI
Suffix:JR
Gender:M
Credentials:PA-C, ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Mailing Address - Street 1:1325 SAN MARCO BLVD
Mailing Address - Street 2:SUITE 701
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32207-8568
Mailing Address - Country:US
Mailing Address - Phone:904-346-3465
Mailing Address - Fax:904-858-6490
Practice Address - Street 1:2 SHIRCLIFF WAY
Practice Address - Street 2:SUITE 300
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32204-4753
Practice Address - Country:US
Practice Address - Phone:904-388-1400
Practice Address - Fax:904-388-9644
Is Sole Proprietor?:No
Enumeration Date:2005-11-02
Last Update Date:2013-11-18
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
FLPA9103279363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLU6024YMedicare PIN
FLQ54272Medicare UPIN