Provider Demographics
NPI:1639649981
Name:TUNSTALL, BRANDON FRANCIS (AGPCNP)
Entity Type:Individual
Prefix:
First Name:BRANDON
Middle Name:FRANCIS
Last Name:TUNSTALL
Suffix:
Gender:M
Credentials:AGPCNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1050 MANTUA PIKE
Mailing Address - Street 2:
Mailing Address - City:WENONAH
Mailing Address - State:NJ
Mailing Address - Zip Code:08090-1141
Mailing Address - Country:US
Mailing Address - Phone:856-210-7679
Mailing Address - Fax:856-210-7526
Practice Address - Street 1:1050 MANTUA PIKE
Practice Address - Street 2:
Practice Address - City:WENONAH
Practice Address - State:NJ
Practice Address - Zip Code:08090-1141
Practice Address - Country:US
Practice Address - Phone:856-210-7679
Practice Address - Fax:856-210-7526
Is Sole Proprietor?:No
Enumeration Date:2018-11-29
Last Update Date:2018-11-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ26NJ00861800363LG0600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LG0600XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGerontology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ83-2672304OtherTAX ID