Provider Demographics
NPI:1942894837
Name:BRUTUS, TRISHA
Entity Type:Individual
Prefix:
First Name:TRISHA
Middle Name:
Last Name:BRUTUS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:TRISHA
Other - Middle Name:
Other - Last Name:BRUTUS
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:TRISHA BRUTUS, PA-C
Mailing Address - Street 1:13370 NE 9TH AVE
Mailing Address - Street 2:
Mailing Address - City:NORTH MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33161-4114
Mailing Address - Country:US
Mailing Address - Phone:954-624-2197
Mailing Address - Fax:
Practice Address - Street 1:13370 NE 9TH AVE
Practice Address - Street 2:
Practice Address - City:NORTH MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33161-4114
Practice Address - Country:US
Practice Address - Phone:954-624-2197
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-02-22
Last Update Date:2023-10-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
2255A2300X
FLPA9115072363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
No2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer