Provider Demographics
NPI:1700037413
Name:GRIFFIN, BRETT M (PA-C)
Entity Type:Individual
Prefix:MR
First Name:BRETT
Middle Name:M
Last Name:GRIFFIN
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5831 BEE RIDGE RD
Mailing Address - Street 2:STE 100
Mailing Address - City:SARASOTA
Mailing Address - State:FL
Mailing Address - Zip Code:34233-5089
Mailing Address - Country:US
Mailing Address - Phone:941-921-2600
Mailing Address - Fax:941-925-8672
Practice Address - Street 1:1950 ARLINGTON ST
Practice Address - Street 2:SUITE 111
Practice Address - City:SARASOTA
Practice Address - State:FL
Practice Address - Zip Code:34239-3507
Practice Address - Country:US
Practice Address - Phone:941-921-2600
Practice Address - Fax:941-925-8672
Is Sole Proprietor?:No
Enumeration Date:2008-10-01
Last Update Date:2019-11-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPA 9104735363AS0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL000601300Medicaid
FLY00ZHOtherBCBS
FL000601300Medicaid