Healthcare Provider Details

I. General information

NPI: 1730724857
Provider Name (Legal Business Name): JOSEPH H BRANNON CAA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/13/2019
Last Update Date: 11/13/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7700 W SUNRISE BLVD
PLANTATION FL
33322-4113
US

IV. Provider business mailing address

3968 105TH AVE N
CLEARWATER FL
33762-5417
US

V. Phone/Fax

Practice location:
  • Phone: 800-437-2672
  • Fax:
Mailing address:
  • Phone: 954-547-4467
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367H00000X
TaxonomyAnesthesiologist Assistant
License Number561
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: