Provider Demographics
NPI:1760024541
Name:QUILES, BRANDIE (APRN, FNP-C)
Entity Type:Individual
Prefix:
First Name:BRANDIE
Middle Name:
Last Name:QUILES
Suffix:
Gender:F
Credentials:APRN, FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:106 BOSTON AVE STE 204
Mailing Address - Street 2:
Mailing Address - City:ALTAMONTE SPRINGS
Mailing Address - State:FL
Mailing Address - Zip Code:32701-4712
Mailing Address - Country:US
Mailing Address - Phone:407-410-7457
Mailing Address - Fax:754-210-2734
Practice Address - Street 1:106 BOSTON AVE STE 204
Practice Address - Street 2:
Practice Address - City:ALTAMONTE SPRINGS
Practice Address - State:FL
Practice Address - Zip Code:32701-4712
Practice Address - Country:US
Practice Address - Phone:407-410-7457
Practice Address - Fax:754-210-2735
Is Sole Proprietor?:No
Enumeration Date:2019-10-13
Last Update Date:2020-12-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL11004666363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLAPRN11004666OtherLICENSE