Provider Demographics
NPI:1164484408
Name:BRANDON, JAN PEARSON (CRNP)
Entity Type:Individual
Prefix:MS
First Name:JAN
Middle Name:PEARSON
Last Name:BRANDON
Suffix:
Gender:F
Credentials:CRNP
Other - Prefix:MS
Other - First Name:JANET
Other - Middle Name:SUSAN
Other - Last Name:PEARSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:CRNP
Mailing Address - Street 1:3701 LOOP RD
Mailing Address - Street 2:
Mailing Address - City:TUSCALOOSA
Mailing Address - State:AL
Mailing Address - Zip Code:35404-5015
Mailing Address - Country:US
Mailing Address - Phone:205-554-2000
Mailing Address - Fax:
Practice Address - Street 1:615 JENNIFER DR E
Practice Address - Street 2:
Practice Address - City:TUSCALOOSA
Practice Address - State:AL
Practice Address - Zip Code:35404-3669
Practice Address - Country:US
Practice Address - Phone:205-554-2000
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-04-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL1-047096363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily