Provider Demographics
NPI:1689285454
Name:MACIAS, BRANDON DAVID (FNP-C)
Entity Type:Individual
Prefix:
First Name:BRANDON
Middle Name:DAVID
Last Name:MACIAS
Suffix:
Gender:M
Credentials:FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7121 S PADRE ISLAND DR
Mailing Address - Street 2:STE 300
Mailing Address - City:CORPUS CHRISTI
Mailing Address - State:TX
Mailing Address - Zip Code:78412-4940
Mailing Address - Country:US
Mailing Address - Phone:361-696-6200
Mailing Address - Fax:361-696-6060
Practice Address - Street 1:7121 S PADRE ISLAND DR STE 300
Practice Address - Street 2:
Practice Address - City:CORPUS CHRISTI
Practice Address - State:TX
Practice Address - Zip Code:78412-4940
Practice Address - Country:US
Practice Address - Phone:361-696-6200
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-08-13
Last Update Date:2020-08-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1006378363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily