Healthcare Provider Details

I. General information

NPI: 1679230387
Provider Name (Legal Business Name): BRANDY ANGELA KUCHARSKI PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/17/2021
Last Update Date: 11/17/2021
Certification Date: 11/17/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7641 66TH ST N
PINELLAS PARK FL
33781-3173
US

IV. Provider business mailing address

8327 JENNIFER LN
SEMINOLE FL
33777-2804
US

V. Phone/Fax

Practice location:
  • Phone: 727-541-4431
  • Fax:
Mailing address:
  • Phone: 239-560-1924
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207N00000X
TaxonomyDermatology Physician
License NumberPAC9114184
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: