Individual
CHANELLE BRUSSEAU
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
500 W 11TH ST, PANAMA CITY, FL 32401-6304
(850) 785-8557
Mailing address
500 W 11TH ST, PANAMA CITY, FL 32401-6304
(850) 785-8557
Taxonomy
Speciality
Code
Description
License number
State
363AM0700X
Medical Physician Assistant
6673
CT
363AM0700X
Medical Physician Assistant
Primary
9119597
FL
Other
Enumeration date
05/22/2024
Last updated
02/20/2025
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