Provider Demographics
NPI:1265898878
Name:SMITH, BRANDI (NP-C)
Entity type:Individual
Prefix:
First Name:BRANDI
Middle Name:
Last Name:SMITH
Suffix:
Gender:F
Credentials:NP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13365 OVERSEAS HWY APT 201
Mailing Address - Street 2:
Mailing Address - City:MARATHON
Mailing Address - State:FL
Mailing Address - Zip Code:33050-3513
Mailing Address - Country:US
Mailing Address - Phone:305-294-0011
Mailing Address - Fax:305-743-9612
Practice Address - Street 1:13365 OVERSEAS HWY STE 102
Practice Address - Street 2:
Practice Address - City:MARATHON
Practice Address - State:FL
Practice Address - Zip Code:33050-3513
Practice Address - Country:US
Practice Address - Phone:305-294-0011
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-01-12
Last Update Date:2022-04-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4704216827363LF0000X
FL11013090363LA2100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI4704216827Medicaid
FL11013090OtherFLORIDA APRN LICENSE