Provider records sourced from NPPES (CMS National Plan & Provider Enumeration System). Data current as of August 10, 2026.
NPIDirectory

Grace Diana Tice, PA-C

Individual provider Physician Assistant · NPI 1104541937

Grace Diana Tice, PA-C is a Physician Assistant in Port Charlotte, Florida. Qualified in 2022, 4 years ago. Practices with Advanced Orthopedic Center of Charlotte County, PA, a 37-clinician group. Licensed in Florida.

Years since qualifying
4
Licensed in
FL
In the registry since
2022
What do these letters mean?
PA-C — Physician Assistant, Certified
A physician assistant who holds current national certification.

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Practice location Address checks out

1641 Tamiami Trl Ste 1
Port Charlotte, FL 33948-1018
Phone: (941) 629-6262
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Pin is approximate — placed at the ZIP-code centre, not the exact door.

Specialties & licences

Physician Assistant (primary) Taxonomy 363A00000X · Licence PA9116492 (FL)

Record details

NPI number1104541937
Entity typeIndividual (Type 1)
GenderFemale
Credentials PA-C
Sole proprietorNo
NPI enumeratedOctober 4, 2022
Last updated in NPPESOctober 4, 2022
Certification dateOctober 4, 2022

Medicare enrollment

From the CMS Doctors & Clinicians file — this clinician is enrolled in Medicare.

Medicare specialtyPHYSICIAN ASSISTANT
Medical schoolOTHER
Graduated 2022 (4 years in practice)
Group practice Advanced Orthopedic Center Of Charlotte County, Pa — 37 clinicians
Accepts Medicare assignment Not indicated
Practice locations3 on file with Medicare

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