Provider Demographics
NPI:1497346217
Name:TERRA, BRANDI MARIE (NP)
Entity Type:Individual
Prefix:
First Name:BRANDI
Middle Name:MARIE
Last Name:TERRA
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:BRANDI
Other - Middle Name:
Other - Last Name:SELF
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:765 MEDICAL CENTER CT STE 216
Mailing Address - Street 2:
Mailing Address - City:CHULA VISTA
Mailing Address - State:CA
Mailing Address - Zip Code:91911-6600
Mailing Address - Country:US
Mailing Address - Phone:619-623-3000
Mailing Address - Fax:619-623-3001
Practice Address - Street 1:765 MEDICAL CENTER CT STE 216
Practice Address - Street 2:
Practice Address - City:CHULA VISTA
Practice Address - State:CA
Practice Address - Zip Code:91911-6600
Practice Address - Country:US
Practice Address - Phone:619-623-3000
Practice Address - Fax:619-623-3001
Is Sole Proprietor?:Yes
Enumeration Date:2021-02-03
Last Update Date:2021-02-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA95016587363L00000X, 207RR0500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No207RR0500XAllopathic & Osteopathic PhysiciansInternal MedicineRheumatology