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General NPI Number Information
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NPI Number | 1407101611
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Entity Type | Individual
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Provider Name | GINA BRAZYLLE KIRKPATRICK D.O.
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Gender | Female
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Dates
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Enumeration Date | 07/13/2012
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Last Update Date | 06/03/2024
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Provider Practice Location Address
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Address Line | 14547 BRUCE B DOWNS BLVD STE D
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City | TAMPA
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State | FL
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Zip | 33613-2709
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Country | US
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Telephone | 813-979-7733
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Fax | 813-355-5061
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Provider Business Mailing Address
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Address Line | 38135 MARKET SQUARE DR
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City | ZEPHYRHILLS
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State | FL
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Zip | 33542-7505
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Country | US
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Telephone | 352-567-0188
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Fax | 813-355-5101
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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 | 208800000X
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Taxonomy Name | Urology Physician
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License Number | OS14835
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License Number State | FL
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