Provider Demographics
NPI:1760664817
Name:MILES, BRANDY M (PA)
Entity Type:Individual
Prefix:
First Name:BRANDY
Middle Name:M
Last Name:MILES
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:BRANDY
Other - Middle Name:R
Other - Last Name:MOYE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:4700 BAYOU BLVD.
Mailing Address - Street 2:SUITE 6
Mailing Address - City:PENSACOLA
Mailing Address - State:FL
Mailing Address - Zip Code:32503-1901
Mailing Address - Country:US
Mailing Address - Phone:850-477-9253
Mailing Address - Fax:850-494-9843
Practice Address - Street 1:4700 BAYOU BLVD.
Practice Address - Street 2:SUITE 6
Practice Address - City:PENSACOLA
Practice Address - State:FL
Practice Address - Zip Code:32503-1901
Practice Address - Country:US
Practice Address - Phone:850-477-9253
Practice Address - Fax:850-494-9843
Is Sole Proprietor?:No
Enumeration Date:2007-11-30
Last Update Date:2019-12-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPA9103936363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical