Provider Demographics
NPI:1043724933
Name:TEEGARDEN, BRANDI MARIE (FNP)
Entity Type:Individual
Prefix:
First Name:BRANDI
Middle Name:MARIE
Last Name:TEEGARDEN
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:BRANDI
Other - Middle Name:MARIE
Other - Last Name:RODRIGUEZ
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:68405 LOS GATOS RD
Mailing Address - Street 2:
Mailing Address - City:CATHEDRAL CITY
Mailing Address - State:UNITED STATES
Mailing Address - Zip Code:92234
Mailing Address - Country:UM
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:79440 CORPORATE CENTER DR
Practice Address - Street 2:
Practice Address - City:LA QUINTA
Practice Address - State:CA
Practice Address - Zip Code:92253-7241
Practice Address - Country:US
Practice Address - Phone:760-777-4067
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-11-30
Last Update Date:2020-01-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA95006793363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily