Individual
MR. BRANDON TIBBITTS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
PA-C
Contact information
Practice address
1290 SILAS DEANE HWY, WETHERSFIELD, CT 06109-4337
(860) 777-1280
(860) 777-1276
Mailing address
113 ELM ST STE 304, ENFIELD, CT 06082-3739
(860) 741-2225
(860) 741-2229
Taxonomy
Speciality
Code
Description
License number
State
207N00000X
Dermatology Physician
003752
CT
363A00000X
Physician Assistant
Primary
003752
CT
Other
Enumeration date
07/02/2013
Last updated
10/10/2023
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