Basic Information
| Provider Information | |||||||||
| NPI: | 1497016406 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | GRAYBILL | ||||||||
| FirstName: | JENNIFER | ||||||||
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| Credential: | DO | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1111 7TH AVE N STE 107 | ||||||||
| Address2: | |||||||||
| City: | ST PETERSBURG | ||||||||
| State: | FL | ||||||||
| PostalCode: | 337051348 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7278941661 | ||||||||
| FaxNumber: | 7278941430 | ||||||||
| Practice Location | |||||||||
| Address1: | 1111 7TH AVE N STE 107 | ||||||||
| Address2: | |||||||||
| City: | ST PETERSBURG | ||||||||
| State: | FL | ||||||||
| PostalCode: | 337051348 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7278941661 | ||||||||
| FaxNumber: | 7278941430 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/06/2012 | ||||||||
| LastUpdateDate: | 04/29/2020 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 04/29/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207Q00000X | OS13602 | FL | N | Allopathic & Osteopathic Physicians | Family Medicine | 207RR0500X | 266937 | NY | N | Allopathic & Osteopathic Physicians | Internal Medicine | Rheumatology | 207R00000X | OS13602 | FL | Y | Allopathic & Osteopathic Physicians | Internal Medicine |
No ID Information.