Provider Demographics
NPI:1003512427
Name:LLAGUNO, BRYLLE CZIMO (PA-C)
Entity Type:Individual
Prefix:
First Name:BRYLLE
Middle Name:CZIMO
Last Name:LLAGUNO
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2954 MALLORY CIR STE 101
Mailing Address - Street 2:
Mailing Address - City:CELEBRATION
Mailing Address - State:FL
Mailing Address - Zip Code:34747-1822
Mailing Address - Country:US
Mailing Address - Phone:321-939-0222
Mailing Address - Fax:321-939-0225
Practice Address - Street 1:2954 MALLORY CIR STE 101
Practice Address - Street 2:
Practice Address - City:CELEBRATION
Practice Address - State:FL
Practice Address - Zip Code:34747-1822
Practice Address - Country:US
Practice Address - Phone:321-939-0222
Practice Address - Fax:321-939-0225
Is Sole Proprietor?:No
Enumeration Date:2023-02-07
Last Update Date:2023-03-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPA9117061363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant