Provider Demographics
NPI:1962010660
Name:ROBERSON, BRANDI JOSETTE (FNP-C)
Entity Type:Individual
Prefix:
First Name:BRANDI
Middle Name:JOSETTE
Last Name:ROBERSON
Suffix:
Gender:F
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 1:143 LAKE LAUREL RD NE
Mailing Address - Street 2:
Mailing Address - City:MILLEDGEVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:31061-9012
Mailing Address - Country:US
Mailing Address - Phone:478-456-0093
Mailing Address - Fax:
Practice Address - Street 1:143 LAKE LAUREL RD NE
Practice Address - Street 2:
Practice Address - City:MILLEDGEVILLE
Practice Address - State:GA
Practice Address - Zip Code:31061-9012
Practice Address - Country:US
Practice Address - Phone:478-456-0093
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-07-20
Last Update Date:2020-07-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN219936363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily