Healthcare Provider Details

I. General information

NPI: 1700579661
Provider Name (Legal Business Name): WILLIAM BRESETTE PA-C, RDN
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/29/2023
Last Update Date: 07/02/2026
Certification Date: 07/02/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

15953 N FLORIDA AVE
LUTZ FL
33549-8102
US

IV. Provider business mailing address

15953 N FLORIDA AVE
LUTZ FL
33549-8102
US

V. Phone/Fax

Practice location:
  • Phone: 813-513-0808
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License NumberND11563
License Number StateFL
# 2
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberPA9121995
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: