Provider Demographics
NPI:1619286481
Name:BRUMENSCHENKEL, NICOLE H (PA-C)
Entity Type:Individual
Prefix:MRS
First Name:NICOLE
Middle Name:H
Last Name:BRUMENSCHENKEL
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 1:1921 WALDEMERE ST STE 609
Mailing Address - Street 2:
Mailing Address - City:SARASOTA
Mailing Address - State:FL
Mailing Address - Zip Code:34239-2913
Mailing Address - Country:US
Mailing Address - Phone:941-917-6500
Mailing Address - Fax:941-917-6504
Practice Address - Street 1:1921 WALDEMERE ST STE 609
Practice Address - Street 2:
Practice Address - City:SARASOTA
Practice Address - State:FL
Practice Address - Zip Code:34239-2913
Practice Address - Country:US
Practice Address - Phone:941-917-6500
Practice Address - Fax:941-917-6504
Is Sole Proprietor?:Yes
Enumeration Date:2010-09-28
Last Update Date:2021-12-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPA 9105490363AS0400X
FLPA9105490363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
No363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical