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General NPI Number Information
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NPI Number | 1750028171
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Entity Type | Individual
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Provider Name | BRIANNA ALYSSA TOVAR ATC, BS
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Gender | Female
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Dates
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Enumeration Date | 05/17/2022
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Last Update Date | 05/17/2022
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Provider Practice Location Address
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Address Line | 2300 EL JOBEAN RD
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City | PORT CHARLOTTE
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State | FL
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Zip | 33948-1109
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Country | US
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Telephone | 941-235-5010
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Fax |
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Provider Business Mailing Address
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Address Line | 640 S VERMONT AVE
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City | MERCEDES
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State | TX
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Zip | 78570-3322
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Country | US
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Telephone | 956-650-3330
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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 | 2255A2300X
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Taxonomy Name | Athletic Trainer
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License Number | 404669
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License Number State |
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