Provider Demographics
NPI:1508445511
Name:PROTZ, BRANDY M (PA -C)
Entity Type:Individual
Prefix:
First Name:BRANDY
Middle Name:M
Last Name:PROTZ
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 1:12428 OLD MERIDIAN ST UNIT 211
Mailing Address - Street 2:
Mailing Address - City:CARMEL
Mailing Address - State:IN
Mailing Address - Zip Code:46032-6114
Mailing Address - Country:US
Mailing Address - Phone:618-339-4464
Mailing Address - Fax:
Practice Address - Street 1:11900 N PENN ST
Practice Address - Street 2:
Practice Address - City:CARMEL
Practice Address - State:IN
Practice Address - Zip Code:46032-4693
Practice Address - Country:US
Practice Address - Phone:317-663-7123
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-04-06
Last Update Date:2021-04-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN10003236A363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical