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General NPI Number Information
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NPI Number | 1740804673
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Entity Type | Individual
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Provider Name | BRIAN WIN PA
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Gender | Male
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Dates
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Enumeration Date | 06/06/2020
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Last Update Date | 11/02/2022
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Provider Practice Location Address
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Address Line | 130 PABLO ST
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City | LAKELAND
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State | FL
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Zip | 33803-3818
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Country | US
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Telephone | 863-284-6800
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Fax | 863-687-1033
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Provider Business Mailing Address
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Address Line | 1600 LAKELAND HILLS BLVD
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City | LAKELAND
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State | FL
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Zip | 33805-3019
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Country | US
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Telephone | 863-680-7000
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Fax | 866-264-8519
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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 | PA9113319
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License Number State | FL
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