Provider Demographics
NPI:1770954257
Name:RUFFO, BRANDI LEA (APRN)
Entity type:Individual
Prefix:
First Name:BRANDI
Middle Name:LEA
Last Name:RUFFO
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:BRANDI
Other - Middle Name:LEA
Other - Last Name:CORY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:APRN
Mailing Address - Street 1:300 E MCBEE AVE FL 4
Mailing Address - Street 2:
Mailing Address - City:GREENVILLE
Mailing Address - State:SC
Mailing Address - Zip Code:29601-2842
Mailing Address - Country:US
Mailing Address - Phone:864-522-8603
Mailing Address - Fax:
Practice Address - Street 1:3907 S HIGHWAY 14
Practice Address - Street 2:
Practice Address - City:GREENVILLE
Practice Address - State:SC
Practice Address - Zip Code:29615-6138
Practice Address - Country:US
Practice Address - Phone:864-522-1300
Practice Address - Fax:864-522-1305
Is Sole Proprietor?:No
Enumeration Date:2015-10-09
Last Update Date:2021-06-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC19637363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCNP3511Medicaid
SCNP3511Medicaid