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General NPI Number Information
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NPI Number | 1033221411
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Entity Type | Individual
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Provider Name | TINA BRUEFACH PA
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Gender | Female
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Dates
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Enumeration Date | 08/31/2006
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Last Update Date | 09/12/2024
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Provider Practice Location Address
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Address Line | 11140 W COLONIAL DR #3
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City | OCOEE
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State | FL
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Zip | 34761-3300
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Country | US
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Telephone | 407-395-7040
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Fax | 407-395-7105
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Provider Business Mailing Address
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Address Line | 10000 W COLONIAL DR
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City | OCOEE
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State | FL
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Zip | 34761-3400
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Country | US
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Telephone | 407-298-6950
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Fax | 407-578-2354
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363AM0700X
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Taxonomy Name | Medical Physician Assistant
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License Number | PA2755
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License Number State | FL
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Taxonomy #2
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Taxonomy Code | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number | PA0002755
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License Number State | FL
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