Healthcare Provider Details

I. General information

NPI: 1861415812
Provider Name (Legal Business Name): LORETTA L BRESTAN MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/25/2006
Last Update Date: 06/26/2026
Certification Date: 06/26/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

14100 FIVAY RD STE 340
HUDSON FL
34667-7181
US

IV. Provider business mailing address

14100 FIVAY RD STE 340
HUDSON FL
34667-7181
US

V. Phone/Fax

Practice location:
  • Phone: 727-861-0237
  • Fax:
Mailing address:
  • Phone: 727-861-0237
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208600000X
TaxonomySurgery Physician
License NumberME96298
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code2086S0127X
TaxonomyTrauma Surgery Physician
License Number01089344A
License Number StateIN
# 3
Primary TaxonomyY
Taxonomy Code2086S0127X
TaxonomyTrauma Surgery Physician
License NumberME96298
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: