Provider Demographics
NPI:1356057830
Name:CONCOLINO, BRANDI
Entity type:Individual
Prefix:
First Name:BRANDI
Middle Name:
Last Name:CONCOLINO
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:801 N MAGNOLIA AVE STE 403
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32803-3844
Mailing Address - Country:US
Mailing Address - Phone:321-800-2922
Mailing Address - Fax:
Practice Address - Street 1:801 N MAGNOLIA AVE STE 403
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32803-3844
Practice Address - Country:US
Practice Address - Phone:321-800-2922
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-01-27
Last Update Date:2023-01-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLEO2392247200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes247200000XTechnologists, Technicians & Other Technical Service ProvidersTechnician, Other
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLEO2392OtherDEPARTMENT OF HEALTH