Provider Demographics
NPI:1053386797
Name:M. SWANN, BRIAN MICHAEL (PA-C)
Entity type:Individual
Prefix:MR
First Name:BRIAN
Middle Name:MICHAEL
Last Name:M. SWANN
Suffix:
Gender:M
Credentials:PA-C
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Mailing Address - Street 1:9912 LITTLE RD DEPT VETERANS
Mailing Address - Street 2:PAS-PCC3
Mailing Address - City:NEW PORT RICHEY
Mailing Address - State:FL
Mailing Address - Zip Code:34654-3419
Mailing Address - Country:US
Mailing Address - Phone:727-869-4100
Mailing Address - Fax:727-869-4196
Practice Address - Street 1:9912 LITTLE RD
Practice Address - Street 2:VA-OPC-NPR / PCC3
Practice Address - City:NEW PORT RICHEY
Practice Address - State:FL
Practice Address - Zip Code:34654-3419
Practice Address - Country:US
Practice Address - Phone:727-869-4100
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-02-17
Last Update Date:2007-07-24
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
FL2308363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant