Healthcare Provider Details

I. General information

NPI: 1093375396
Provider Name (Legal Business Name): BRIANNA COLLINS SPAHN PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/18/2019
Last Update Date: 06/18/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

19 DAVIS AVE FL 1
NEPTUNE NJ
07753-4488
US

IV. Provider business mailing address

157 COMANCHE DR
OCEANPORT NJ
07757-1763
US

V. Phone/Fax

Practice location:
  • Phone: 732-263-7960
  • Fax:
Mailing address:
  • Phone: 908-433-9235
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number25MP00524900
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: