Provider Demographics
NPI:1073587440
Name:BRANDT, JARED ROBERT (PA-C)
Entity Type:Individual
Prefix:
First Name:JARED
Middle Name:ROBERT
Last Name:BRANDT
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:75 PRINGLE WAY
Mailing Address - Street 2:SUITE 804
Mailing Address - City:RENO
Mailing Address - State:NV
Mailing Address - Zip Code:89502-1464
Mailing Address - Country:US
Mailing Address - Phone:775-829-7999
Mailing Address - Fax:775-829-7970
Practice Address - Street 1:75 PRINGLE WAY
Practice Address - Street 2:SUITE 1002
Practice Address - City:RENO
Practice Address - State:NV
Practice Address - Zip Code:89502-1464
Practice Address - Country:US
Practice Address - Phone:775-326-9132
Practice Address - Fax:775-336-3345
Is Sole Proprietor?:No
Enumeration Date:2006-02-14
Last Update Date:2012-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NVPA898363AM0700X, 363AS0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
No363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NV100505905Medicaid
NV100505905Medicaid
NVQ43081Medicare UPIN