Provider Demographics
NPI:1700560091
Name:BRANCH, BRANDI (RN)
Entity Type:Individual
Prefix:
First Name:BRANDI
Middle Name:
Last Name:BRANCH
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8043 SIERRA OAKS BLVD
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32219-1999
Mailing Address - Country:US
Mailing Address - Phone:321-710-9961
Mailing Address - Fax:
Practice Address - Street 1:8043 SIERRA OAKS BLVD
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32219-1999
Practice Address - Country:US
Practice Address - Phone:321-710-9961
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-06-15
Last Update Date:2023-06-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLRN9351144163WM0102X, 251E00000X, 163WP1700X
374J00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WP1700XNursing Service ProvidersRegistered NursePerinatal
No163WM0102XNursing Service ProvidersRegistered NurseMaternal Newborn
No251E00000XAgenciesHome Health
No374J00000XNursing Service Related ProvidersDoula