Provider Demographics
NPI:1306848957
Name:GRENIER, JOCELYN CARIN (PA)
Entity type:Individual
Prefix:
First Name:JOCELYN
Middle Name:CARIN
Last Name:GRENIER
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3001 CORAL HILLS DR
Mailing Address - Street 2:SUITE 320
Mailing Address - City:CORAL SPRINGS
Mailing Address - State:FL
Mailing Address - Zip Code:33065-4172
Mailing Address - Country:US
Mailing Address - Phone:954-755-0111
Mailing Address - Fax:954-755-2209
Practice Address - Street 1:3001 CORAL HILLS DR
Practice Address - Street 2:SUITE 320
Practice Address - City:CORAL SPRINGS
Practice Address - State:FL
Practice Address - Zip Code:33065-4172
Practice Address - Country:US
Practice Address - Phone:954-755-0111
Practice Address - Fax:954-755-2209
Is Sole Proprietor?:No
Enumeration Date:2005-08-12
Last Update Date:2014-08-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPA9102519363AS0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL290967OtherAVMED
FL995399OtherNHP
FL291666500Medicaid
FLP97977Medicare UPIN
FL291666500Medicaid