Provider Demographics
NPI:1396620670
Name:HERRERA, GRECIA SOFIA (PHYSICIAN ASSISTANT)
Entity type:Individual
Prefix:
First Name:GRECIA
Middle Name:SOFIA
Last Name:HERRERA
Suffix:
Gender:F
Credentials:PHYSICIAN ASSISTANT
Other - Prefix:
Other - First Name:GRECIA
Other - Middle Name:SOFIA
Other - Last Name:HERRERA
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:PHYSICIAN ASSISTANT
Mailing Address - Street 1:1234 FAN PALM DR
Mailing Address - Street 2:
Mailing Address - City:DAVENPORT
Mailing Address - State:FL
Mailing Address - Zip Code:33897-5738
Mailing Address - Country:US
Mailing Address - Phone:407-766-3868
Mailing Address - Fax:
Practice Address - Street 1:52 CALLE ANTONIO LOPEZ S
Practice Address - Street 2:
Practice Address - City:HUMACAO
Practice Address - State:PR
Practice Address - Zip Code:00791-4206
Practice Address - Country:US
Practice Address - Phone:787-602-9055
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-08-07
Last Update Date:2025-08-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR2674-P.A.363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant