Provider Demographics
NPI:1730564923
Name:FLORENCE, BRANDEN MICHAEL (PA-C)
Entity type:Individual
Prefix:
First Name:BRANDEN
Middle Name:MICHAEL
Last Name:FLORENCE
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:206 E ELM ST
Mailing Address - Street 2:
Mailing Address - City:CALDWELL
Mailing Address - State:ID
Mailing Address - Zip Code:83605-4815
Mailing Address - Country:US
Mailing Address - Phone:208-459-4511
Mailing Address - Fax:208-459-6602
Practice Address - Street 1:206 E ELM ST
Practice Address - Street 2:
Practice Address - City:CALDWELL
Practice Address - State:ID
Practice Address - Zip Code:83605-4815
Practice Address - Country:US
Practice Address - Phone:208-459-4511
Practice Address - Fax:208-459-6602
Is Sole Proprietor?:No
Enumeration Date:2015-07-29
Last Update Date:2016-03-31
Deactivation Date:
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Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant