Basic Information
| Provider Information | |||||||||
| NPI: | 1225512072 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | BOTSCH | ||||||||
| FirstName: | BRANDI | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2405 SE 17TH ST STE 201 | ||||||||
| Address2: | |||||||||
| City: | OCALA | ||||||||
| State: | FL | ||||||||
| PostalCode: | 344719190 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3526902171 | ||||||||
| FaxNumber: | 3526906954 | ||||||||
| Practice Location | |||||||||
| Address1: | 2640 SW 32ND PL | ||||||||
| Address2: | |||||||||
| City: | OCALA | ||||||||
| State: | FL | ||||||||
| PostalCode: | 344717847 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3523691099 | ||||||||
| FaxNumber: | 3523690299 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 09/18/2018 | ||||||||
| LastUpdateDate: | 02/01/2022 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 09/28/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363A00000X | PAT9111496 | FL | Y | Physician Assistants & Advanced Practice Nursing Providers | Physician Assistant |
No ID Information.