Healthcare Provider Details

I. General information

NPI: 1447230933
Provider Name (Legal Business Name): TOMMY JASON BRACKINS PA-C
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/19/2006
Last Update Date: 05/26/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

COMDT (CG-1122) U.S. COAST GUARD 2100 2ND ST SW SUITE 5314
WASHINGTON DC
20593-0001
US

IV. Provider business mailing address

COMDT (CG-1122) U.S. COAST GUARD 2100 2ND ST SW SUITE 5314
WASHINGTON DC
20593-0001
US

V. Phone/Fax

Practice location:
  • Phone: 305-953-2261
  • Fax: 305-953-2251
Mailing address:
  • Phone: 865-599-8870
  • Fax: 865-599-8870

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: