Healthcare Provider Details

I. General information

NPI: 1376131680
Provider Name (Legal Business Name): BRYAN SEIPLE
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/04/2021
Last Update Date: 01/04/2021
Certification Date: 01/04/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1607 SAINT JAMES CT STE 2
TALLAHASSEE FL
32308-4658
US

IV. Provider business mailing address

4174 LAUREL OAK CIR
TALLAHASSEE FL
32311-4183
US

V. Phone/Fax

Practice location:
  • Phone: 850-878-8714
  • Fax:
Mailing address:
  • Phone: 386-479-7445
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: