Provider Demographics
NPI:1689621633
Name:BRANTMAN, ANNE ELIZABETH (RN CNS NP)
Entity Type:Individual
Prefix:
First Name:ANNE
Middle Name:ELIZABETH
Last Name:BRANTMAN
Suffix:
Gender:F
Credentials:RN CNS NP
Other - Prefix:
Other - First Name:ANNE
Other - Middle Name:BRANTMAN
Other - Last Name:MCCORKINDALE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 609001
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92160-9001
Mailing Address - Country:US
Mailing Address - Phone:619-528-4600
Mailing Address - Fax:619-528-4625
Practice Address - Street 1:328 ENCINITAS BLVD
Practice Address - Street 2:#100
Practice Address - City:ENCINITAS
Practice Address - State:CA
Practice Address - Zip Code:92024-8704
Practice Address - Country:US
Practice Address - Phone:760-730-4540
Practice Address - Fax:760-274-2094
Is Sole Proprietor?:No
Enumeration Date:2006-05-27
Last Update Date:2010-01-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CARN561764163W00000X
CANP12343363LP0808X
CACNS1427364SP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No163W00000XNursing Service ProvidersRegistered Nurse
No364SP0808XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse SpecialistPsychiatric/Mental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAWNP12343AMedicare PIN
CABC102ZMedicare PIN
CAQ72123Medicare UPIN
CAW416Medicare PIN