Individual
ANDREA TOMASEK GRIMBALL
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA-C
Contact information
Practice address
27 MEDICAL CENTER DR, JACKSON, TN 38301-3949
(731) 424-1001
Mailing address
27 MEDICAL CENTER DR, JACKSON, TN 38301-3949
(731) 424-1001
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
PA0000001561
TN
363A00000X
Physician Assistant
PA9101918
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
009976550
—
AL
01
—
059051687
BCBS OF ALABAMA
AL
05
—
291182500
—
FL
01
—
970023893
RAILROAD MEDICARE
—
Enumeration date
10/04/2006
Last updated
03/24/2009
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