Provider Demographics
NPI:1508749532
Name:PARKER, BRIANNE ELIZABETH (PA-C)
Entity type:Individual
Prefix:
First Name:BRIANNE
Middle Name:ELIZABETH
Last Name:PARKER
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 1:5802 BEAR LAKE CIR
Mailing Address - Street 2:
Mailing Address - City:FOREST CITY
Mailing Address - State:FL
Mailing Address - Zip Code:32703-1976
Mailing Address - Country:US
Mailing Address - Phone:407-405-5066
Mailing Address - Fax:
Practice Address - Street 1:785 PRIMERA BLVD
Practice Address - Street 2:
Practice Address - City:LAKE MARY
Practice Address - State:FL
Practice Address - Zip Code:32746-2124
Practice Address - Country:US
Practice Address - Phone:407-834-8111
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-07-28
Last Update Date:2025-08-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
363A00000X
FLPA9120521207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGroup - Single Specialty
No363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant