Basic Information
| Provider Information | |||||||||
| NPI: | 1306848957 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | GRENIER | ||||||||
| FirstName: | JOCELYN | ||||||||
| MiddleName: | CARIN | ||||||||
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| Credential: | PA | ||||||||
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| Mailing Information | |||||||||
| Address1: | 3001 CORAL HILLS DR | ||||||||
| Address2: | SUITE 320 | ||||||||
| City: | CORAL SPRINGS | ||||||||
| State: | FL | ||||||||
| PostalCode: | 330654172 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9547550111 | ||||||||
| FaxNumber: | 9547552209 | ||||||||
| Practice Location | |||||||||
| Address1: | 3001 CORAL HILLS DR | ||||||||
| Address2: | SUITE 320 | ||||||||
| City: | CORAL SPRINGS | ||||||||
| State: | FL | ||||||||
| PostalCode: | 330654172 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9547550111 | ||||||||
| FaxNumber: | 9547552209 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/12/2005 | ||||||||
| LastUpdateDate: | 08/07/2014 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363AS0400X | PA9102519 | FL | Y | Physician Assistants & Advanced Practice Nursing Providers | Physician Assistant | Surgical |
ID Information
| ID | Type | State | Issuer | Description | 290967 | 01 | FL | AVMED | OTHER | 995399 | 01 | FL | NHP | OTHER | 291666500 | 05 | FL | MEDICAID |