Provider Demographics
NPI:1538263959
Name:BRAZIL, SUSAN JOANNA (PA-C)
Entity type:Individual
Prefix:
First Name:SUSAN
Middle Name:JOANNA
Last Name:BRAZIL
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 1:600 UNIVERSITY BLVD.
Mailing Address - Street 2:SUITE-200
Mailing Address - City:JUPITER
Mailing Address - State:FL
Mailing Address - Zip Code:33458
Mailing Address - Country:US
Mailing Address - Phone:561-627-2210
Mailing Address - Fax:561-627-5850
Practice Address - Street 1:600 UNIVERSITY BLVD.
Practice Address - Street 2:SUITE-200
Practice Address - City:JUPITER
Practice Address - State:FL
Practice Address - Zip Code:33458
Practice Address - Country:US
Practice Address - Phone:561-627-2210
Practice Address - Fax:561-627-5850
Is Sole Proprietor?:No
Enumeration Date:2006-09-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPA3369363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLPA3369OtherSTATE LICENSE