Bourgeois, Brad
Bourgeois, Brad is an individual health care provider with primary practice located at 201 N Lakemont Ave , Winter Park FL 32792-3228. He recently has only one registered license in Physician Assistants & Advanced Practice Nursing Providers / Nurse Practitioner, which is considered as his primary health care specialty. Bourgeois, Brad can be contacted via phone (407) 790-4205.Contact Information
Primary practice address
201 N Lakemont Ave
Winter Park FL 32792-3228
Phone: (407) 790-4205
Fax:
Website:
Health care specialties
Specialty | Code | License # | State |
---|---|---|---|
Physician Assistants & Advanced Practice Nursing Providers / Nurse Practitioner | 363L00000X | AP08638 | Louisiana |
Profile Details
NPI number | 1982066783 |
---|---|
LBN Legal business name | Bourgeois, Brad |
Credentials | |
Entity | Individual |
Sole proprietor 1 | No |
Enumeration date | Mar 22nd, 2016 |
Last updated | Jan 28th, 2019 - about 5 years ago |
1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.
Identifiers
State | Type | Number | Issuer |
---|---|---|---|
All States | NPI | 1982066783 | NPPES |
Louisiana | MEDICAID | 2416243 |
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