MEDICARE: BREEA BUCKLEY 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
1	363A00000X	Physician Assistant	PA9109726	FL

Other Identifiers

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

General Provider Information

NPI Number	:	1447706684
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	BREEA BUCKLEY PA-C

Provider Business Mailing Address
First Line	:	PO BOX 102222
Second Line	:	ATTN: CREDENTIAILNG
City	:	ATLANTA
State	:	GA
Zip	:	30368-2222
Country	:	US
Telephone Number	:	239-274-8200
Fax Number	:

Provider Business Practice Location Address
First Line	:	400 PINELLAS ST
Second Line	:	SUITE 300
City	:	CLEARWATER
State	:	FL
Zip	:	33756-3312
Country	:	US
Telephone Number	:	727-447-8100
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/28/2016
Last Update Date	:	03/05/2026

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Directions to “ BREEA BUCKLEY PA-C” Practice Location

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