Provider Demographics
NPI:1225512072
Name:BOTSCH, BRANDI (PA-C)
Entity Type:Individual
Prefix:
First Name:BRANDI
Middle Name:
Last Name:BOTSCH
Suffix:
Gender:F
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 1:2120 E JOHNSON AVE STE 106
Mailing Address - Street 2:
Mailing Address - City:PENSACOLA
Mailing Address - State:FL
Mailing Address - Zip Code:32514-6091
Mailing Address - Country:US
Mailing Address - Phone:850-494-6003
Mailing Address - Fax:877-718-1039
Practice Address - Street 1:2120 E JOHNSON AVE STE 106
Practice Address - Street 2:
Practice Address - City:PENSACOLA
Practice Address - State:FL
Practice Address - Zip Code:32514-6091
Practice Address - Country:US
Practice Address - Phone:850-494-6003
Practice Address - Fax:877-718-1039
Is Sole Proprietor?:No
Enumeration Date:2018-09-18
Last Update Date:2023-05-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPAT9111496363A00000X
FLPA9111496363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant