Individual
BRANDY MANCHE WILEY
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA-C
Contact information
Practice address
4343 W NEWBERRY RD, SUITE 3, GAINESVILLE, FL 32607-2817
(352) 374-2222
Mailing address
4881 NW 8TH AVE, SUITE 2, GAINESVILLE, FL 32605-4582
(352) 547-2373
(352) 416-1813
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
P9107304
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
009327800
—
FL
01
—
Y0P28
BC/BS
FL
Enumeration date
07/03/2013
Last updated
12/16/2014
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