Provider Demographics
NPI:1679230387
Name:KUCHARSKI, BRANDY ANGELA (PA-C)
Entity Type:Individual
Prefix:
First Name:BRANDY
Middle Name:ANGELA
Last Name:KUCHARSKI
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 1:8327 JENNIFER LN
Mailing Address - Street 2:
Mailing Address - City:SEMINOLE
Mailing Address - State:FL
Mailing Address - Zip Code:33777-2804
Mailing Address - Country:US
Mailing Address - Phone:239-560-1924
Mailing Address - Fax:
Practice Address - Street 1:7641 66TH ST N
Practice Address - Street 2:
Practice Address - City:PINELLAS PARK
Practice Address - State:FL
Practice Address - Zip Code:33781-3173
Practice Address - Country:US
Practice Address - Phone:727-541-4431
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-11-17
Last Update Date:2021-11-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPAC9114184207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatologyGroup - Single Specialty