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General NPI Number Information
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NPI Number | 1659720241
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Entity Type | Individual
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Provider Name | WILLIE FRAZIER
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Gender | Male
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Dates
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Enumeration Date | 06/06/2016
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Last Update Date | 12/22/2017
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Provider Practice Location Address
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Address Line | 1312 MANATEE AVE E
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City | BRADENTON
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State | FL
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Zip | 34208-1358
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Country | US
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Telephone | 941-708-8700
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Fax | 941-708-8706
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Provider Business Mailing Address
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Address Line | 1936 BRUCE B DOWNS BLVD SUITE 75
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City | WESLEY CHAPEL
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State | FL
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Zip | 33544-9262
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Country | US
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Telephone | 813-997-0960
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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 | 363L00000X
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Taxonomy Name | Nurse Practitioner
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License Number | ARNP9356813
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License Number State | FL
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