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General NPI Number Information
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NPI Number | 1578395992
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Entity Type | Individual
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Provider Name | BRETTE BEAN PA-C
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Gender |
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Dates
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Enumeration Date | 08/14/2024
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Last Update Date | 03/09/2025
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Provider Practice Location Address
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Address Line | 140 S BEACH ST STE 202
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City | DAYTONA BEACH
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State | FL
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Zip | 32114-4409
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Country | US
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Telephone | 888-506-8838
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Fax | 888-506-8837
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Provider Business Mailing Address
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Address Line | 2975 67TH WAY N
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City | SAINT PETERSBURG
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State | FL
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Zip | 33710-3136
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Country | US
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Telephone |
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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 | 207N00000X
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Taxonomy Name | Dermatology Physician
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License Number | PA9118272
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License Number State | FL
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Taxonomy #2
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Taxonomy Code | 207P00000X
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Taxonomy Name | Emergency Medicine Physician
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License Number | PA9118272
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License Number State | FL
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