Doctor Name: | MRS. DENISE MARIE BREAZEALE |
NPI Number: | 1023181799 |
Entity Type Code: | Individual (1) |
Gender: | F |
Credentials: | FNP-C |
License Number: | APN 2581 |
Business Practice Address: | 2318 Sunset Blvd Agape Physicians Care West Columbia, SC - 291694716 |
Business Phone Number: | 8034543510 |
Business Fax Number: | 8558669360 |
Mailing Address: | 1624 Main Street Agape Senior Primary Care, Inc.,, Dba Agape Physicians Care COLUMBIA |
State: | SC |
Postal Code: | 29201 |
Phone Number: | 8034540365 |
Fax Number: | 8034046000 |
NPI Enumeration Date: | 11/17/2006 |
NPI Last Update Date: | 12/02/2014 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 363LF0000X |
License Number: | APN 2581 |
Healthcare Provider Taxonomy: (Secondary) | N |
State: | SC |
Taxonomy Type: | Physician Assistants & Advanced Practice Nursing Providers |
Taxonomy Classification: | Nurse Practitioner |
Taxonomy Specialization: | Family |
Taxonomy Definition: |