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BRIELLE MARIE BUCKLEY PA
>> Physician Assistant >> Physician Assistants & Advanced Practice Nursing ProvidersRegistrant NPI Number: 1528218815
Individual Registrant: BRIELLE MARIE BUCKLEY PA
Gender: F
Not Sole Proprietor
Gender: F
Not Sole Proprietor
Location and contact information for practice:
801 WELLNESS WAY STE 107 SEBASTIAN, FL 32958 US
Tel: 772-226-4200 Fax: 772-581-5781
Tel: 772-226-4200 Fax: 772-581-5781
Contact information for business:
1000 36TH ST VERO BEACH, FL 32960-4862 US
Tel: 772-567-4311 Fax: 772-563-4641
Tel: 772-567-4311 Fax: 772-563-4641
Registration Information:
NPI: 1528218815
Entity Type: Individual
Entity Type: Individual
Specialty information:
| Primary | Code | Category/Description | State | License Number |
|---|---|---|---|---|
| N | 363A00000X | Physician Assistants & Advanced Practice Nursing Providers Physician Assistant | TX | PA07418 |
| Y | 363A00000X | Physician Assistants & Advanced Practice Nursing Providers Physician Assistant | FL | PA9110318 |
Legacy codes, insurance codes and state license numbers:
| Issuer | Number | State | Type |
|---|---|---|---|
| 328101601 | TX | 05 | |
| BCBS | 8697NJ | TX | 01 |
| BCBS | 8663ND | TX | 01 |
