Provider Demographics
NPI:1770305252
Name:BRAND, BRIANNA (RDN, CPT)
Entity type:Individual
Prefix:
First Name:BRIANNA
Middle Name:
Last Name:BRAND
Suffix:
Gender:F
Credentials:RDN, CPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1675 POST OAK CT
Mailing Address - Street 2:
Mailing Address - City:ORANGE PARK
Mailing Address - State:FL
Mailing Address - Zip Code:32073-3615
Mailing Address - Country:US
Mailing Address - Phone:904-333-7163
Mailing Address - Fax:
Practice Address - Street 1:1675 POST OAK CT
Practice Address - Street 2:
Practice Address - City:ORANGE PARK
Practice Address - State:FL
Practice Address - Zip Code:32073-3615
Practice Address - Country:US
Practice Address - Phone:904-333-7163
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-10-28
Last Update Date:2024-10-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL86331563133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered