Provider Demographics
NPI:1952799140
Name:GRAZETTE, JJAY D (PT ASPT HT)
Entity Type:Individual
Prefix:
First Name:JJAY
Middle Name:D
Last Name:GRAZETTE
Suffix:
Gender:M
Credentials:PT ASPT HT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2505 FLAGLER AVE
Mailing Address - Street 2:
Mailing Address - City:KEY WEST
Mailing Address - State:FL
Mailing Address - Zip Code:33040-3934
Mailing Address - Country:US
Mailing Address - Phone:305-587-4894
Mailing Address - Fax:
Practice Address - Street 1:2505 FLAGLER AVE
Practice Address - Street 2:
Practice Address - City:KEY WEST
Practice Address - State:FL
Practice Address - Zip Code:33040-3934
Practice Address - Country:US
Practice Address - Phone:305-587-4994
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-12-23
Last Update Date:2020-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL640828030014172V00000X, 246RP1900X, 374700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes246RP1900XTechnologists, Technicians & Other Technical Service ProvidersTechnician, PathologyPhlebotomy
No172V00000XOther Service ProvidersCommunity Health Worker
No374700000XNursing Service Related ProvidersTechnician
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL141125085651Other141125085651-30026666753