Provider Demographics
NPI:1396553244
Name:BRANDT, GINA SMITH (RN, BSN, AMB-BC)
Entity type:Individual
Prefix:MRS
First Name:GINA
Middle Name:SMITH
Last Name:BRANDT
Suffix:
Gender:F
Credentials:RN, BSN, AMB-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14 PATTON DR
Mailing Address - Street 2:
Mailing Address - City:NEWPORT NEWS
Mailing Address - State:VA
Mailing Address - Zip Code:23606-1716
Mailing Address - Country:US
Mailing Address - Phone:757-719-1286
Mailing Address - Fax:
Practice Address - Street 1:MCDONALD ARMY HEALTH CENTER
Practice Address - Street 2:576 JEFFERSON AVE
Practice Address - City:JBLE-FORT EUSTIS
Practice Address - State:VA
Practice Address - Zip Code:23604
Practice Address - Country:US
Practice Address - Phone:757-314-7698
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-12-24
Last Update Date:2024-12-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0001129928163WP2201X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WP2201XNursing Service ProvidersRegistered NurseAmbulatory Care