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Individual

MRS. RENAE LEA DEGRELLA

Active
Sole proprietor
No

Provider details

NPI number
Gender
F
Credential
PA-C

Contact information

Practice address
4301 N HABANA AVE, TAMPA, FL 33607-6546
(813) 879-5010
(813) 443-8148
Mailing address
4301 N HABANA AVE, TAMPA, FL 33607-6546
(813) 879-5010
(813) 443-8148

Taxonomy

Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
001887
CT
363A00000X
Physician Assistant
PA9108819
FL
363AS0400X
Surgical Physician Assistant
Primary
PA9108819
FL

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
015437600
FL
Enumeration date
03/01/2007
Last updated
04/20/2023
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