Provider Demographics
NPI:1841543451
Name:ACERO, BREANNA MARY GRACE (PA-C)
Entity type:Individual
Prefix:
First Name:BREANNA
Middle Name:MARY GRACE
Last Name:ACERO
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:BREANNA
Other - Middle Name:M
Other - Last Name:BRAVO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA-C
Mailing Address - Street 1:338 HOWARD BLVD
Mailing Address - Street 2:PO BOX 969
Mailing Address - City:NEWPORT
Mailing Address - State:NC
Mailing Address - Zip Code:28570-7928
Mailing Address - Country:US
Mailing Address - Phone:252-223-5054
Mailing Address - Fax:252-223-4038
Practice Address - Street 1:338 HOWARD BLVD
Practice Address - Street 2:
Practice Address - City:NEWPORT
Practice Address - State:NC
Practice Address - Zip Code:28570-7928
Practice Address - Country:US
Practice Address - Phone:252-223-5054
Practice Address - Fax:252-223-4038
Is Sole Proprietor?:No
Enumeration Date:2012-10-19
Last Update Date:2015-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC0010-03846363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant