Provider Demographics
NPI:1003466830
Name:HILLARD, BRANDON NEIL (APRN)
Entity Type:Individual
Prefix:MR
First Name:BRANDON
Middle Name:NEIL
Last Name:HILLARD
Suffix:
Gender:M
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:4656 TUNIS STREET
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32205
Mailing Address - Country:US
Mailing Address - Phone:904-662-4853
Mailing Address - Fax:604-212-0381
Practice Address - Street 1:4401 EMERSON ST STE 8
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32207-4954
Practice Address - Country:US
Practice Address - Phone:904-387-9406
Practice Address - Fax:904-212-0381
Is Sole Proprietor?:No
Enumeration Date:2019-09-13
Last Update Date:2023-04-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLRN9423141163W00000X, 163WH0200X
FLAPRN11010517363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No163W00000XNursing Service ProvidersRegistered Nurse
No163WH0200XNursing Service ProvidersRegistered NurseHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL100682400Medicaid