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:
Map and Directions

Health care specialties

SpecialtyCodeLicense #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.

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Identifiers

StateTypeNumberIssuer
All States NPI 1982066783 NPPES
Louisiana MEDICAID 2416243

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