Individual
CAROL BRUGGEMAN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA-C
Contact information
Practice address
1600 SW ARCHER RD, GAINESVILLE, FL 32610
(352) 265-0111
Mailing address
1230 PENMAN RD, JACKSONVILLE, FL 32250-3670
(941) 993-7754
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
PA9111178
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1982100939
—
FL
01
—
PA9111178
FLORIDA DEPARTMENT OF HEALTH
FL
Enumeration date
03/30/2018
Last updated
07/29/2018
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