Provider Demographics
NPI:1578296588
Name:GALLEGO, BRANDI NICOLE (APRN)
Entity Type:Individual
Prefix:MRS
First Name:BRANDI
Middle Name:NICOLE
Last Name:GALLEGO
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 1:2996 TRASONA DR
Mailing Address - Street 2:
Mailing Address - City:MELBOURNE
Mailing Address - State:FL
Mailing Address - Zip Code:32940-7686
Mailing Address - Country:US
Mailing Address - Phone:813-997-7989
Mailing Address - Fax:
Practice Address - Street 1:6619 N WICKHAM RD
Practice Address - Street 2:
Practice Address - City:MELBOURNE
Practice Address - State:FL
Practice Address - Zip Code:32940-2006
Practice Address - Country:US
Practice Address - Phone:321-259-9500
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-07-07
Last Update Date:2022-07-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAPRN11020643363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily