Provider Demographics
NPI:1265088595
Name:KOCH, BRANDI SHANELL (RNFA)
Entity type:Individual
Prefix:
First Name:BRANDI
Middle Name:SHANELL
Last Name:KOCH
Suffix:
Gender:F
Credentials:RNFA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3334 CAPITAL MEDICAL BLVD STE 400
Mailing Address - Street 2:
Mailing Address - City:TALLAHASSEE
Mailing Address - State:FL
Mailing Address - Zip Code:32308-4470
Mailing Address - Country:US
Mailing Address - Phone:850-877-8174
Mailing Address - Fax:844-261-6839
Practice Address - Street 1:2605 WELAUNEE BLVD
Practice Address - Street 2:
Practice Address - City:TALLAHASSEE
Practice Address - State:FL
Practice Address - Zip Code:32308-4697
Practice Address - Country:US
Practice Address - Phone:850-877-8174
Practice Address - Fax:844-261-6839
Is Sole Proprietor?:Yes
Enumeration Date:2019-08-13
Last Update Date:2021-05-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLRN9385824163WR0006X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WR0006XNursing Service ProvidersRegistered NurseRegistered Nurse First Assistant