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General NPI Number Information
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NPI Number | 1255503843
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Entity Type | Individual
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Provider Name | BRIAN FRANKLIN PETRINE PA
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Gender | Male
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Dates
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Enumeration Date | 03/24/2008
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Last Update Date | 10/09/2020
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Provider Practice Location Address
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Address Line | 4205 BELFORT RD SUITE 1100
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City | JACKSONVILLE
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State | FL
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Zip | 32216
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Country | US
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Telephone | 904-296-3103
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Fax | 904-296-3106
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Provider Business Mailing Address
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Address Line | 4500 SAN PABLO RD S
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City | JACKSONVILLE
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State | FL
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Zip | 32224-1865
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Country | US
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Telephone | 904-953-2000
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Fax |
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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 | 363AS0400X
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Taxonomy Name | Surgical Physician Assistant
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License Number | PA9104481
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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 | PA9104481
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License Number State | FL
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