Provider Demographics
NPI:1497232797
Name:RICHARDSON, BRANDI (APRN)
Entity Type:Individual
Prefix:
First Name:BRANDI
Middle Name:
Last Name:RICHARDSON
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:325 JOHN KNOX RD STE D101
Mailing Address - Street 2:
Mailing Address - City:TALLAHASSEE
Mailing Address - State:FL
Mailing Address - Zip Code:32303-4158
Mailing Address - Country:US
Mailing Address - Phone:850-755-3808
Mailing Address - Fax:
Practice Address - Street 1:325 JOHN KNOX RD STE D101
Practice Address - Street 2:
Practice Address - City:TALLAHASSEE
Practice Address - State:FL
Practice Address - Zip Code:32303-4158
Practice Address - Country:US
Practice Address - Phone:850-329-2932
Practice Address - Fax:866-208-4378
Is Sole Proprietor?:No
Enumeration Date:2018-07-19
Last Update Date:2023-07-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAPRN9347402363LA2200X, 363LG0600X, 363LP0808X, 363LP2300X, 363L00000X, 363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
No363LG0600XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGerontology
No363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No363LP2300XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPrimary Care