Provider Demographics
NPI:1326461617
Name:BEBBLE, BRIANNON (PA-C)
Entity type:Individual
Prefix:
First Name:BRIANNON
Middle Name:
Last Name:BEBBLE
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2100 SE HILLMOOR DR STE 101
Mailing Address - Street 2:
Mailing Address - City:PORT ST LUCIE
Mailing Address - State:FL
Mailing Address - Zip Code:34952-8057
Mailing Address - Country:US
Mailing Address - Phone:561-303-3011
Mailing Address - Fax:
Practice Address - Street 1:2100 SE HILLMOOR DR STE 101
Practice Address - Street 2:
Practice Address - City:PORT ST LUCIE
Practice Address - State:FL
Practice Address - Zip Code:34952-8057
Practice Address - Country:US
Practice Address - Phone:561-303-3011
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-01-23
Last Update Date:2025-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPA9107772363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLHR577YMedicare PIN