Individual
MR. BRIAN ROBERT HACKETT
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PA-C
Contact information
Practice address
240 N WICKHAM RD STE 104, MELBOURNE, FL 32935-8663
(321) 541-1777
(321) 541-1786
Mailing address
240 N WICKHAM RD STE 104, MELBOURNE, FL 32935-8663
(321) 541-1777
(321) 541-1786
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
PA9106102
FL
363AS0400X
Surgical Physician Assistant
Primary
PA9106102
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
008056700
—
FL
Enumeration date
08/22/2011
Last updated
12/15/2025
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