Healthcare Provider Details

I. General information

NPI: 1740700608
Provider Name (Legal Business Name): BRYAN CASE PA-C
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/22/2017
Last Update Date: 10/07/2026
Certification Date: 10/07/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5151 WINTER GARDEN VINELAND RD STE 206
WINDERMERE FL
34786-6098
US

IV. Provider business mailing address

5151 WINTER GARDEN VINELAND RD STE 206
WINDERMERE FL
34786-6098
US

V. Phone/Fax

Practice location:
  • Phone: 407-629-2444
  • Fax: 407-643-2801
Mailing address:
  • Phone: 407-629-2444
  • Fax: 407-643-2801

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number0110009355
License Number StateVA
# 2
Primary TaxonomyY
Taxonomy Code363AS0400X
TaxonomySurgical Physician Assistant
License NumberPA9121643
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: