Provider Demographics
NPI:1174720874
Name:DESTIN PLASTIC SURGERY
Entity type:Organization
Organization Name:DESTIN PLASTIC SURGERY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE STAFF
Authorized Official - Prefix:MRS
Authorized Official - First Name:BRANDIE
Authorized Official - Middle Name:
Authorized Official - Last Name:SENN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:850-650-7606
Mailing Address - Street 1:4485 FURLING LN
Mailing Address - Street 2:
Mailing Address - City:DESTIN
Mailing Address - State:FL
Mailing Address - Zip Code:32541-5331
Mailing Address - Country:US
Mailing Address - Phone:850-654-1194
Mailing Address - Fax:850-337-1698
Practice Address - Street 1:4485 FURLING LN
Practice Address - Street 2:
Practice Address - City:DESTIN
Practice Address - State:FL
Practice Address - Zip Code:32541-5331
Practice Address - Country:US
Practice Address - Phone:850-654-1194
Practice Address - Fax:850-337-1698
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-06-27
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty