Provider Demographics
NPI:1598229700
Name:RODGERS, BRANDON JAMES (RN)
Entity Type:Individual
Prefix:
First Name:BRANDON
Middle Name:JAMES
Last Name:RODGERS
Suffix:
Gender:M
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:7751 BELFORT PKWY STE 120
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32256-6921
Mailing Address - Country:US
Mailing Address - Phone:904-372-3943
Mailing Address - Fax:904-212-1618
Practice Address - Street 1:7751 BELFORT PKWY STE 120
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32256-6921
Practice Address - Country:US
Practice Address - Phone:904-372-3943
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-01-22
Last Update Date:2023-09-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL1-162411363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL1-162411OtherALABAMA BOARD OF NURSING