Healthcare Provider Details

I. General information

NPI: 1952954315
Provider Name (Legal Business Name): BRENDAN GRANT CORTRIGHT PA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/24/2019
Last Update Date: 11/04/2024
Certification Date: 11/04/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1285 CREEKSIDE BLVD E UNIT 102
NAPLES FL
34109-0595
US

IV. Provider business mailing address

10036 VIA COLOMBA CIR
FORT MYERS FL
33966-6512
US

V. Phone/Fax

Practice location:
  • Phone: 239-624-1700
  • Fax: 239-624-0311
Mailing address:
  • Phone: 518-593-6980
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number9112287
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: