Provider Demographics
NPI:1407101611
Name:KIRKPATRICK, GINA BRAZYLLE (DO)
Entity Type:Individual
Prefix:DR
First Name:GINA
Middle Name:BRAZYLLE
Last Name:KIRKPATRICK
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:GINA
Other - Middle Name:
Other - Last Name:KIRKPATRICK REESE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:2700 HEALING WAY STE 310
Mailing Address - Street 2:
Mailing Address - City:WESLEY CHAPEL
Mailing Address - State:FL
Mailing Address - Zip Code:33543-5453
Mailing Address - Country:US
Mailing Address - Phone:813-779-1209
Mailing Address - Fax:813-779-1216
Practice Address - Street 1:2700 HEALING WAY STE 310
Practice Address - Street 2:
Practice Address - City:WESLEY CHAPEL
Practice Address - State:FL
Practice Address - Zip Code:33543-5453
Practice Address - Country:US
Practice Address - Phone:813-779-1209
Practice Address - Fax:813-779-1216
Is Sole Proprietor?:No
Enumeration Date:2012-07-13
Last Update Date:2020-08-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOS14835208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208800000XAllopathic & Osteopathic PhysiciansUrology