Provider Demographics
NPI:1982901856
Name:GRENELLE, PAUL MICHAEL LEE (PA)
Entity Type:Individual
Prefix:MR
First Name:PAUL
Middle Name:MICHAEL LEE
Last Name:GRENELLE
Suffix:
Gender:M
Credentials:PA
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Mailing Address - Street 1:PO BOX 864074
Mailing Address - Street 2:HALIFAX HEALTHCARE SYSTEMS, INC.
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32886-4074
Mailing Address - Country:US
Mailing Address - Phone:386-226-4590
Mailing Address - Fax:386-226-3371
Practice Address - Street 1:303 NO. CLYDE MORRIS BLVD.
Practice Address - Street 2:HALIFAX MEDICAL CENTER
Practice Address - City:DAYTONA BEACH
Practice Address - State:FL
Practice Address - Zip Code:32114-2709
Practice Address - Country:US
Practice Address - Phone:386-425-2285
Practice Address - Fax:386-425-7522
Is Sole Proprietor?:No
Enumeration Date:2011-02-11
Last Update Date:2012-01-18
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Provider Licenses
StateLicense IDTaxonomies
FLPA9105871363AS0400X, 363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
No363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical