Healthcare Provider Details

I. General information

NPI: 1083346381
Provider Name (Legal Business Name): SUZANNE BRINSON PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/27/2022
Last Update Date: 02/19/2025
Certification Date: 02/19/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

657 DEL PRADO BLVD S STE 300
CAPE CORAL FL
33990-2660
US

IV. Provider business mailing address

7331 COLLEGE PKWY STE 300
FORT MYERS FL
33907-5524
US

V. Phone/Fax

Practice location:
  • Phone: 239-337-2003
  • Fax: 239-337-3168
Mailing address:
  • Phone: 239-337-2003
  • Fax: 239-337-3168

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberPA9116907
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: