Provider Demographics
NPI:1962901140
Name:BROTHERS, DARIAN DOLORES DIANE
Entity type:Individual
Prefix:
First Name:DARIAN
Middle Name:DOLORES DIANE
Last Name:BROTHERS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:103 W ALBANY LN
Mailing Address - Street 2:
Mailing Address - City:HERNANDO
Mailing Address - State:FL
Mailing Address - Zip Code:34442-3304
Mailing Address - Country:US
Mailing Address - Phone:727-992-1636
Mailing Address - Fax:
Practice Address - Street 1:103 W ALBANY LN
Practice Address - Street 2:
Practice Address - City:HERNANDO
Practice Address - State:FL
Practice Address - Zip Code:34442-3304
Practice Address - Country:US
Practice Address - Phone:727-992-1636
Practice Address - Fax:727-992-1636
Is Sole Proprietor?:Yes
Enumeration Date:2018-02-02
Last Update Date:2018-02-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
No2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer