Provider Demographics
NPI:1508257999
Name:BLACK, AMINA BRANDY (CRNA, MSN)
Entity Type:Individual
Prefix:
First Name:AMINA
Middle Name:BRANDY
Last Name:BLACK
Suffix:
Gender:F
Credentials:CRNA, MSN
Other - Prefix:
Other - First Name:AMINA
Other - Middle Name:BRANDY
Other - Last Name:CHIN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:8243 101ST CT
Mailing Address - Street 2:
Mailing Address - City:SEMINOLE
Mailing Address - State:FL
Mailing Address - Zip Code:33777-1836
Mailing Address - Country:US
Mailing Address - Phone:727-417-1859
Mailing Address - Fax:
Practice Address - Street 1:616 E ST
Practice Address - Street 2:
Practice Address - City:CLEARWATER
Practice Address - State:FL
Practice Address - Zip Code:33756-3342
Practice Address - Country:US
Practice Address - Phone:727-447-0888
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-02-06
Last Update Date:2024-05-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL106047367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered