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NPI Code Detail

MEDICARE: MR. JOE MCKINLEY BRADEN PA-C

MEDICARE: MR. JOE MCKINLEY BRADEN 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
1363A00000XPhysician AssistantPA9101501FL

General Provider Information

NPI Number : 1619960804
Entity Type Code : Individual
Provider Name (Legal Business Name) : MR. JOE MCKINLEY BRADEN PA-C
Provider Business Mailing Address
First Line : 282 APOLLO BEACH BLVD
Second Line :
City : APOLLO BEACH
State : FL
Zip : 33572-2261
Country : US
Telephone Number : 813-645-4068
Fax Number : 813-645-0312
Provider Business Practice Location Address
First Line : 282 APOLLO BEACH BLVD
Second Line :
City : APOLLO BEACH
State : FL
Zip : 33572-2261
Country : US
Telephone Number : 813-645-4068
Fax Number : 813-645-0312
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 08/24/2005
Last Update Date : 10/17/2019

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