Individual
BRIANNA VINCENT
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA-C
Contact information
Practice address
2105 JUNIPER LAKE RD STE A, WEST END, NC 27376-9051
(910) 684-1588
Mailing address
130 SHORT RD, PINEHURST, NC 28374-8814
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
0010-07222
NC
363AM0700X
Medical Physician Assistant
52259
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0010-07222
NORTH CAROLINA PA LICENSE
NC
Enumeration date
01/26/2015
Last updated
03/31/2021
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