Healthcare Provider Details

I. General information

NPI: 1366956229
Provider Name (Legal Business Name): BRIAN MATTHEW BOYLE PA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/29/2017
Last Update Date: 10/28/2025
Certification Date: 10/28/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3000 MEDICAL PARK DR STE 320
TAMPA FL
33613-4681
US

IV. Provider business mailing address

3000 MEDICAL PARK DR
TAMPA FL
33613-4680
US

V. Phone/Fax

Practice location:
  • Phone: 813-336-5766
  • Fax:
Mailing address:
  • Phone: 813-336-5766
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number0010-08949
License Number StateNC
# 2
Primary TaxonomyY
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License NumberPA9119492
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: