Provider Demographics
NPI:1710465315
Name:BRAZZELL, DELIA MARIA
Entity Type:Individual
Prefix:
First Name:DELIA
Middle Name:MARIA
Last Name:BRAZZELL
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1014 AIRPORT RD UNIT 162
Mailing Address - Street 2:
Mailing Address - City:DESTIN
Mailing Address - State:FL
Mailing Address - Zip Code:32541-2889
Mailing Address - Country:US
Mailing Address - Phone:850-346-2955
Mailing Address - Fax:
Practice Address - Street 1:509 SE RIVERSIDE DR STE 303
Practice Address - Street 2:
Practice Address - City:STUART
Practice Address - State:FL
Practice Address - Zip Code:34994-2579
Practice Address - Country:US
Practice Address - Phone:772-283-9111
Practice Address - Fax:772-283-2955
Is Sole Proprietor?:No
Enumeration Date:2018-08-06
Last Update Date:2022-04-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAPRN9319069363LF0000X, 363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily