Provider Demographics
NPI:1003520321
Name:ROSARIO, BRANDON (PA)
Entity Type:Individual
Prefix:
First Name:BRANDON
Middle Name:
Last Name:ROSARIO
Suffix:
Gender:M
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1040 SW 2ND AVE
Mailing Address - Street 2:
Mailing Address - City:OCALA
Mailing Address - State:FL
Mailing Address - Zip Code:34471-0926
Mailing Address - Country:US
Mailing Address - Phone:352-732-3005
Mailing Address - Fax:352-732-8977
Practice Address - Street 1:1040 SW 2ND AVE
Practice Address - Street 2:
Practice Address - City:OCALA
Practice Address - State:FL
Practice Address - Zip Code:34471-0926
Practice Address - Country:US
Practice Address - Phone:352-732-3005
Practice Address - Fax:352-732-8977
Is Sole Proprietor?:No
Enumeration Date:2023-01-11
Last Update Date:2023-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPAT9116868363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLPAT9116868OtherSTATE OF FLORIDA DEPT OF HEALTH