Provider Demographics
NPI:1023825338
Name:TEKALEC, BRANDI NICOLE (CNP)
Entity type:Individual
Prefix:
First Name:BRANDI
Middle Name:NICOLE
Last Name:TEKALEC
Suffix:
Gender:F
Credentials:CNP
Other - Prefix:
Other - First Name:BRANDI
Other - Middle Name:NICOLE
Other - Last Name:KUNDRAT
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:CNP
Mailing Address - Street 1:805 COLUMBIA RD STE 109
Mailing Address - Street 2:
Mailing Address - City:WESTLAKE
Mailing Address - State:OH
Mailing Address - Zip Code:44145-1461
Mailing Address - Country:US
Mailing Address - Phone:330-460-8364
Mailing Address - Fax:216-227-2628
Practice Address - Street 1:9050 N CHURCH DR
Practice Address - Street 2:
Practice Address - City:PARMA HEIGHTS
Practice Address - State:OH
Practice Address - Zip Code:44130-4701
Practice Address - Country:US
Practice Address - Phone:440-292-0226
Practice Address - Fax:440-292-0225
Is Sole Proprietor?:No
Enumeration Date:2024-12-11
Last Update Date:2024-12-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHAG10240030363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner