Individual
BRITTANY BANDY
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
490 CENTRE LAKE DR NE STE 200B, PALM BAY, FL 32907-1189
(321) 784-8211
(321) 394-9425
Mailing address
490 CENTRE LAKE DR NE STE 200B, PALM BAY, FL 32907-1189
(321) 784-8211
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
310589
LA
363A00000X
Physician Assistant
Primary
PA9115766
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1152714
PHYSICIAN ASSISTANT CERTIFICATION
—
01
—
310589
PHYSICIAN ASSISTANT STATE LICENSE
LA
01
—
PA9115766
PHYSICIAN ASSISTANT STATE LICENSE
FL
Enumeration date
11/19/2018
Last updated
03/11/2022
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