Provider Demographics
NPI:1386701399
Name:GRABOWSKI, TIMOTHY (PA-C)
Entity type:Individual
Prefix:MR
First Name:TIMOTHY
Middle Name:
Last Name:GRABOWSKI
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3210 CLEVELAND AVE STE 100
Mailing Address - Street 2:
Mailing Address - City:FORT MYERS
Mailing Address - State:FL
Mailing Address - Zip Code:33901-7182
Mailing Address - Country:US
Mailing Address - Phone:239-574-0011
Mailing Address - Fax:239-574-4020
Practice Address - Street 1:2721 DEL PRADO BLVD S STE 250
Practice Address - Street 2:
Practice Address - City:CAPE CORAL
Practice Address - State:FL
Practice Address - Zip Code:33904-5710
Practice Address - Country:US
Practice Address - Phone:239-574-0011
Practice Address - Fax:239-574-4020
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-02
Last Update Date:2010-04-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPA9102919363AS0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL0664623OtherAETNA HMO
FL4374392OtherAETNA PPO
FL592207264EOtherHUMANA
FL18915OtherBCBS
FL583807358OtherCHAMPUS
FL592207264OtherCIGNA PPO
FL0599674OtherGHI PPO
FL373039500Medicaid
FL3911740004OtherCIGNA HMO
FL0905525OtherUHC
FL0626040002Medicare NSC
FL0626040001Medicare NSC
FL592207264OtherCIGNA PPO
FL373039500Medicaid
FL0664623OtherAETNA HMO