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NPI Code Detail

MEDICARE: BRODIE PRUITT PA-C

MEDICARE: BRODIE PRUITT PA-C
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1207P00000XEmergency Medicine Physician0010-13707NC
2363A00000XPhysician AssistantPA9116205FL

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1285371427
Entity Type Code : Individual
Provider Name (Legal Business Name) : BRODIE PRUITT PA-C
Provider Business Mailing Address
First Line : 601 E ROLLINS ST
Second Line :
City : ORLANDO
State : FL
Zip : 32803-1248
Country : US
Telephone Number : 407-303-6413
Fax Number : 407-303-6414
Provider Business Practice Location Address
First Line : 601 E ROLLINS ST
Second Line :
City : ORLANDO
State : FL
Zip : 32803-1248
Country : US
Telephone Number : 407-303-6413
Fax Number : 407-303-6414
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 05/18/2022
Last Update Date : 02/03/2026

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Directions to “ BRODIE PRUITT PA-C” Practice Location

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