Provider Demographics
NPI:1417026907
Name:D'ANTONIO, BRANDY DRAUGHON (FNP)
Entity Type:Individual
Prefix:
First Name:BRANDY
Middle Name:DRAUGHON
Last Name:D'ANTONIO
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:110 KINGSLEY LN
Mailing Address - Street 2:SUITE 106
Mailing Address - City:NORFOLK
Mailing Address - State:VA
Mailing Address - Zip Code:23505-4614
Mailing Address - Country:US
Mailing Address - Phone:757-889-5735
Mailing Address - Fax:757-889-5742
Practice Address - Street 1:110 KINGSLEY LN
Practice Address - Street 2:SUITE 106
Practice Address - City:NORFOLK
Practice Address - State:VA
Practice Address - Zip Code:23505-4614
Practice Address - Country:US
Practice Address - Phone:757-889-5735
Practice Address - Fax:757-889-5742
Is Sole Proprietor?:No
Enumeration Date:2006-11-07
Last Update Date:2007-12-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0024167077174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist