Provider Demographics
NPI:1760468383
Name:JERNANDER, BRANDI S (NP-C)
Entity Type:Individual
Prefix:
First Name:BRANDI
Middle Name:S
Last Name:JERNANDER
Suffix:
Gender:F
Credentials:NP-C
Other - Prefix:
Other - First Name:BRANDI
Other - Middle Name:S
Other - Last Name:RAMBO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:NP
Mailing Address - Street 1:222 PERRY HWY
Mailing Address - Street 2:BLDG A
Mailing Address - City:HAWKINSVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:31036-6748
Mailing Address - Country:US
Mailing Address - Phone:478-783-4307
Mailing Address - Fax:478-783-4309
Practice Address - Street 1:222 PERRY HWY
Practice Address - Street 2:BLDG A
Practice Address - City:HAWKINSVILLE
Practice Address - State:GA
Practice Address - Zip Code:31036-6748
Practice Address - Country:US
Practice Address - Phone:478-783-4307
Practice Address - Fax:478-783-4309
Is Sole Proprietor?:No
Enumeration Date:2005-12-15
Last Update Date:2016-02-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN149163 NP363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA432259684AMedicaid
GA432259684BMedicaid
GA432259684BMedicaid