Provider Demographics
NPI:1073005724
Name:BRACETE, GERALD ALFRED (FNP-BC)
Entity Type:Individual
Prefix:MR
First Name:GERALD
Middle Name:ALFRED
Last Name:BRACETE
Suffix:
Gender:M
Credentials:FNP-BC
Other - Prefix:MR
Other - First Name:GERALD
Other - Middle Name:ALFRED
Other - Last Name:BRACETE COLLAZO
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:FNP-BC
Mailing Address - Street 1:500 LAKESHORE PKWY
Mailing Address - Street 2:
Mailing Address - City:ROCK HILL
Mailing Address - State:SC
Mailing Address - Zip Code:29730-4273
Mailing Address - Country:US
Mailing Address - Phone:803-909-6363
Mailing Address - Fax:803-909-6364
Practice Address - Street 1:500 LAKESHORE PKWY
Practice Address - Street 2:
Practice Address - City:ROCK HILL
Practice Address - State:SC
Practice Address - Zip Code:29730-4273
Practice Address - Country:US
Practice Address - Phone:803-909-6363
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-05-30
Last Update Date:2018-05-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC21862363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily