Individual
BRANDI L. BROUGHTON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PHYSICIAN ASSISTANT
Contact information
Practice address
12900 CORTEZ BLVD STE 205, BROOKSVILLE, FL 34613-4898
(813) 321-1786
(813) 321-1787
Mailing address
4651 VAN DYKE RD, LUTZ, FL 33558-4880
(813) 321-1786
(813) 321-1787
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
PA 9104237
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
PA9104237
LICENSE
FL
Enumeration date
09/19/2007
Last updated
01/16/2019
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