Provider Demographics
NPI:1336576750
Name:NIEVES, BRANDON JOSHUA (PA-C)
Entity Type:Individual
Prefix:
First Name:BRANDON
Middle Name:JOSHUA
Last Name:NIEVES
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:151 SOUTHHALL LN
Mailing Address - Street 2:STE 300
Mailing Address - City:MAITLAND
Mailing Address - State:FL
Mailing Address - Zip Code:32751-7176
Mailing Address - Country:US
Mailing Address - Phone:407-875-2080
Mailing Address - Fax:407-650-3455
Practice Address - Street 1:14050 TOWN LOOP BLVD
Practice Address - Street 2:STE 203
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32837-6190
Practice Address - Country:US
Practice Address - Phone:407-852-6650
Practice Address - Fax:407-852-6035
Is Sole Proprietor?:Yes
Enumeration Date:2013-09-30
Last Update Date:2014-05-20
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
FLPA9107503363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant