Provider Demographics
NPI:1043719248
Name:BRANGACCIO, DAVID
Entity Type:Individual
Prefix:MR
First Name:DAVID
Middle Name:
Last Name:BRANGACCIO
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4101 HERITAGE LAKE CT
Mailing Address - Street 2:
Mailing Address - City:LUTZ
Mailing Address - State:FL
Mailing Address - Zip Code:33558-9725
Mailing Address - Country:US
Mailing Address - Phone:813-436-1845
Mailing Address - Fax:
Practice Address - Street 1:4101 HERITAGE LAKE CT
Practice Address - Street 2:
Practice Address - City:LUTZ
Practice Address - State:FL
Practice Address - Zip Code:33558-9725
Practice Address - Country:US
Practice Address - Phone:813-436-1845
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-02-03
Last Update Date:2018-02-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
No2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer