Provider Demographics
NPI:1295064764
Name:DOCTOR, BRANDI DANIELLE (APRN)
Entity type:Individual
Prefix:MISS
First Name:BRANDI
Middle Name:DANIELLE
Last Name:DOCTOR
Suffix:
Gender:F
Credentials:APRN
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Mailing Address - Street 1:720 BROOKER CREEK BLVD STE 215
Mailing Address - Street 2:
Mailing Address - City:OLDSMAR
Mailing Address - State:FL
Mailing Address - Zip Code:34677-2937
Mailing Address - Country:US
Mailing Address - Phone:813-854-2003
Mailing Address - Fax:813-436-5378
Practice Address - Street 1:116 HARBOR VILLAGE LN
Practice Address - Street 2:
Practice Address - City:APOLLO BEACH
Practice Address - State:FL
Practice Address - Zip Code:33572-3402
Practice Address - Country:US
Practice Address - Phone:813-493-1779
Practice Address - Fax:813-641-3821
Is Sole Proprietor?:No
Enumeration Date:2009-12-13
Last Update Date:2024-01-27
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Provider Licenses
StateLicense IDTaxonomies
FLARNP9214074363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL001778700Medicaid
FLY01X5OtherBLUE CROSS BLUE SHIELD
FLCV146ZMedicare PIN