GRACE FANTL (NPI# 1710461595) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1710461595 |
| Entity Type | Individual |
| Full Name | GRACE FANTL |
| Credential | PA-C |
| Practice Address |
27950 Us Highway 27 Leesburg FL 34748-9050 |
| Practice Telephone | 3523505230 |
| Mailing Telephone | 3523505230 |
| Enumeration Date | 2018-09-18 |
| Last Update Date | 2018-09-18 |
| Gender Code | F |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 363AM0700X |
Physician Assistant Specialization: Medical |
PA9111607 | FL | Physician Assistants & Advanced Practice Nursing Providers |
| Street Address |
27950 US HIGHWAY 27 |
| City | LEESBURG |
| State | FL |
| Zip Code | 34748-9050 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1992035695 | Macinnis Dermatology | Dermatology | 27950 Us Highway 27, Leesburg, FL 34748-9050 | 2010-01-04 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1437610243 | Ashley Shamsa Martin | Behavior Technician | 292 Bent Oak Ct, Leesburg, FL 34748 | 2019-03-26 |
| 1891278875 | Luis O Aponte Mendoza | Physician Assistant | 704 Doctors Ct., Suite 101, Leesburg, FL 34748 | 2018-09-14 |
| 1881197903 | Physician Associates LLC | Internal Medicine | 22316 Us Highway 27, Leesburg, FL 34748 | 2018-03-15 |
| 1184136145 | Infinite Support Services LLC | In Home Supportive Care | 129 Grove Ridge Circle, 104, Leesburg, FL 34748 | 2017-10-31 |
| 1619403037 | Massage and Wellness Care | Health Maintenance Organization | 1218 W. Dixie Ave, Suite A, Leesburg, FL 34748 | 2017-05-04 |
| 1497202675 | Prime Radiology of Leesburg Inc | Radiology | 600 N W Blvd, Suite E, Leesburg, FL 34748 | 2016-09-06 |
| 1023480332 | Juanita Elizabeth Simpson | Contractor | 1911 Harcourt Drive, Leesburg, FL 34748 | 2015-10-26 |
| 1467835900 | Serenity Choice Place, LLC | Community/Behavioral Health | 721 Balmoral Circle, Leesburg, FL 34748 | 2015-07-01 |
| 1356738397 | Touching Heart's Group Homes, LLC | Community/Behavioral Health | 31809 Sunpark Cir, Leesburg, FL 34748 | 2015-04-16 |
| 1386035269 | Adventist Health System/sunbelt, Inc. | Clinic/Center | 1103 N 14th Street, Leesburg, FL 34748 | 2015-02-12 |
| Find all providers in zip 34748 | ||||
| Taxonomy Code | 363AM0700X |
| Grouping | Physician Assistants & Advanced Practice Nursing Providers |
| Classification | Physician Assistant |
| Specialization | Medical |
| Definition to come... |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1811439169 | Anthony Mark Rodrigues | Physician Assistant | 224 Cornwall St Nw Ste D, Leesburg, VA 20176-2701 | 2016-11-16 |
| 1770828774 | John O'hara Snow | Physician Assistant | 18706 Woodburn Rd, Leesburg, VA 20175-9030 | 2012-12-01 |
| 1285622829 | John A Horn | Physician Assistant | 600 Dixie Hwy, Leesburg, FL 34748 | 2005-10-07 |
| 1285195487 | Elizabeth Baek | Physician Assistant | 19450 Deerfield Ave Ste 325, Leesburg, VA 20176-8503 | 2019-03-29 |
| 1437629490 | Alexandrea Weeks | Physician Assistant | 1801 Us Highway 441 Bldg 100, Leesburg, FL 34748-2545 | 2018-12-03 |
| 1588061956 | Jaster Francis | Physician Assistant | 44035 Riverside Pkwy, Leesburg, VA 20176 | 2014-12-01 |
| 1073919197 | Alexandra Jean Bache | Physician Assistant | 44035 Riverside Pkwy Ste 400, Leesburg, VA 20176-8260 | 2014-11-17 |
| 1821492067 | Kelly Ashley Boardman | Physician Assistant | 19415 Deerfield Ave, Suite 213, Leesburg, VA 20176-8452 | 2014-10-17 |
| 1437564911 | Ellen T. Godfrey | Physician Assistant | 601 Potomac Station Dr Ne, Leesburg, VA 20176-1816 | 2014-06-24 |
| 1497993802 | Ilyas Gutale | Physician Assistant | 600 E Dixie Ave, Leesburg, FL 34748-5925 | 2009-01-23 |
| Find all providers in LEESBURG | ||||
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.