Healthcare Provider Details

I. General information

NPI: 1790179125
Provider Name (Legal Business Name): BRANDON G VIOLETTE PA-C
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/24/2015
Last Update Date: 12/16/2025
Certification Date: 12/16/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1801 S OSPREY AVE UNIT 201
SARASOTA FL
34239-3625
US

IV. Provider business mailing address

4197 WOODLANDS PKWY
PALM HARBOR FL
34685-3493
US

V. Phone/Fax

Practice location:
  • Phone: 941-957-4767
  • Fax: 941-955-7334
Mailing address:
  • Phone: 813-333-1512
  • Fax: 813-333-1561

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberPA9108546
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: