Provider Demographics
NPI:1992206221
Name:NUTTLE, BRIANNA L (PA)
Entity Type:Individual
Prefix:
First Name:BRIANNA
Middle Name:L
Last Name:NUTTLE
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:BRIANNA
Other - Middle Name:
Other - Last Name:FIOCCO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:275 NORTHPOINTE PKWY STE 50
Mailing Address - Street 2:
Mailing Address - City:AMHERST
Mailing Address - State:NY
Mailing Address - Zip Code:14228-1895
Mailing Address - Country:US
Mailing Address - Phone:716-389-3294
Mailing Address - Fax:716-639-1382
Practice Address - Street 1:1540 MAPLE RD
Practice Address - Street 2:
Practice Address - City:WILLIAMSVILLE
Practice Address - State:NY
Practice Address - Zip Code:14221-3647
Practice Address - Country:US
Practice Address - Phone:716-568-3600
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-02-22
Last Update Date:2023-10-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY021869363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant