Individual
BRIELLE MARIE BUCKLEY
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA
Contact information
Practice address
801 WELLNESS WAY STE 107, SEBASTIAN, FL 32958
(772) 226-4200
(772) 581-5781
Mailing address
1000 36TH ST, VERO BEACH, FL 32960-4862
(772) 567-4311
(772) 563-4641
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
PA07418
TX
363A00000X
Physician Assistant
Primary
PA9110318
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
328101601
—
TX
01
—
8663ND
BCBS
TX
01
—
8697NJ
BCBS
TX
Enumeration date
09/24/2008
Last updated
09/25/2019
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