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BRANDON BRADDOCK PA-C
>> Physician Assistant >> Physician Assistants & Advanced Practice Nursing ProvidersRegistrant NPI Number: 1336536697
Individual Registrant: BRANDON BRADDOCK PA-C
Gender: M
Sole Proprietor
Gender: M
Sole Proprietor
Location and contact information for practice:
300 HEALTH PARK BLVD SUITE 4000 SAINT AUGUSTINE, FL 32086-3707 US
Tel: 904-824-8666 Fax: --
Tel: 904-824-8666 Fax: --
Contact information for business:
300 HEALTH PARK BLVD SUITE 4000 SAINT AUGUSTINE, FL 32086-3707 US
Tel: 904-824-8666 Fax: --
Tel: 904-824-8666 Fax: --
Registration Information:
NPI: 1336536697
Entity Type: Individual
Entity Type: Individual
Specialty information:
| Primary | Code | Category/Description | State | License Number |
|---|---|---|---|---|
| Y | 363A00000X | Physician Assistants & Advanced Practice Nursing Providers Physician Assistant | FL | PA9108661 |
Legacy codes, insurance codes and state license numbers:
| Issuer | Number | State | Type |
|---|---|---|---|
