Provider Demographics
NPI:1942677869
Name:WILLIAMS, BRICKLIN
Entity Type:Individual
Prefix:
First Name:BRICKLIN
Middle Name:
Last Name:WILLIAMS
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 4201
Mailing Address - Street 2:
Mailing Address - City:DEERFIELD BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33442-4201
Mailing Address - Country:US
Mailing Address - Phone:954-274-5619
Mailing Address - Fax:754-227-5792
Practice Address - Street 1:3467 W HILLSBORO BLVD
Practice Address - Street 2:SUITE B
Practice Address - City:DEERFIELD BEACH
Practice Address - State:FL
Practice Address - Zip Code:33442-9473
Practice Address - Country:US
Practice Address - Phone:954-274-5619
Practice Address - Fax:754-227-5792
Is Sole Proprietor?:No
Enumeration Date:2015-08-26
Last Update Date:2019-12-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL15-450246ZC0007X
363AS0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical
No246ZC0007XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, OtherSurgical Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL15-450OtherAMERICAN BOARD OF SURGICAL ASSITANTS