Provider Demographics
NPI:1972025179
Name:HABKOUK, BRANDON C (DNP, APRN)
Entity Type:Individual
Prefix:DR
First Name:BRANDON
Middle Name:C
Last Name:HABKOUK
Suffix:
Gender:M
Credentials:DNP, APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5050 POPLAR AVE STE 800
Mailing Address - Street 2:
Mailing Address - City:MEMPHIS
Mailing Address - State:TN
Mailing Address - Zip Code:38157-0800
Mailing Address - Country:US
Mailing Address - Phone:901-276-2662
Mailing Address - Fax:901-274-2033
Practice Address - Street 1:5050 POPLAR AVE STE 800
Practice Address - Street 2:
Practice Address - City:MEMPHIS
Practice Address - State:TN
Practice Address - Zip Code:38157-0800
Practice Address - Country:US
Practice Address - Phone:901-276-2662
Practice Address - Fax:901-274-2033
Is Sole Proprietor?:Yes
Enumeration Date:2017-07-10
Last Update Date:2021-06-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN191357163W00000X
TN22919363LA2100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care
No163W00000XNursing Service ProvidersRegistered Nurse