Healthcare Provider Details

I. General information

NPI: 1063914562
Provider Name (Legal Business Name): ALEXANDER BRIGANTTY - VAZQUEZ SR. CRNA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/01/2018
Last Update Date: 01/14/2021
Certification Date: 01/14/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7700 W SUNRISE BLVD
PLANTATION FL
33322-4113
US

IV. Provider business mailing address

1329 SW 16TH ST ROOM 2232
GAINESVILLE FL
32610
US

V. Phone/Fax

Practice location:
  • Phone: 954-939-6588
  • Fax:
Mailing address:
  • Phone: 352-733-0485
  • Fax: 352-265-8077

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License NumberAPRN9482935
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number115464
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: