Individual
KIM BRAZLEY
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
P.A.
Contact information
Practice address
1550 BARKLEY CIR, FORT MYERS, FL 33907-4539
(239) 938-2000
(239) 278-0404
Mailing address
1550 BARKLEY CIR, FORT MYERS, FL 33907-4539
(239) 938-2000
(239) 278-0404
Taxonomy
Speciality
Code
Description
License number
State
363AM0700X
Medical Physician Assistant
Primary
PA9102785
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
107759500
—
FL
01
—
12716838
CAQH
—
01
—
1858637
CIGNA
—
01
—
P1019612
FREEDOM HEALTH
—
01
—
S64042
UPIN
—
01
—
Y06MR
BCBS
—
Enumeration date
07/02/2006
Last updated
04/17/2025
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