MEDICARE: BRIANNA VINCENT PA-C

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363AM0700X	Medical Physician Assistant	52259	CA
2	363A00000X	Physician Assistant	0010-07222	NC

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	0010-07222	OTHER	NC	NORTH CAROLINA PA LICENSE

General Provider Information

NPI Number	:	1629468913
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	BRIANNA VINCENT PA-C

Provider Business Mailing Address
First Line	:	130 SHORT RD
Second Line	:
City	:	PINEHURST
State	:	NC
Zip	:	28374-8814
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	2105 JUNIPER LAKE RD STE A
Second Line	:
City	:	WEST END
State	:	NC
Zip	:	27376-9051
Country	:	US
Telephone Number	:	910-684-1588
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/26/2015
Last Update Date	:	03/31/2021

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Directions to “ BRIANNA VINCENT PA-C” Practice Location

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