Provider Demographics
NPI:1841938719
Name:BROCIOUS, BRANDI (PNP)
Entity type:Individual
Prefix:
First Name:BRANDI
Middle Name:
Last Name:BROCIOUS
Suffix:
Gender:F
Credentials:PNP
Other - Prefix:
Other - First Name:BRANDI
Other - Middle Name:
Other - Last Name:BROCIOUS
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:RN, CCRN, PNP
Mailing Address - Street 1:601 ELMWOOD AVE BOX 635
Mailing Address - Street 2:
Mailing Address - City:ROCHESTER
Mailing Address - State:NY
Mailing Address - Zip Code:14642-1632
Mailing Address - Country:US
Mailing Address - Phone:585-274-4606
Mailing Address - Fax:
Practice Address - Street 1:601 ELMWOOD AVE
Practice Address - Street 2:
Practice Address - City:ROCHESTER
Practice Address - State:NY
Practice Address - Zip Code:14642-0001
Practice Address - Country:US
Practice Address - Phone:585-274-6021
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-05-21
Last Update Date:2023-07-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY630374163WN0002X
NY383387207RC0200X, 363LN0000X, 363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics
No163WN0002XNursing Service ProvidersRegistered NurseNeonatal Intensive Care
No207RC0200XAllopathic & Osteopathic PhysiciansInternal MedicineCritical Care Medicine
No363LN0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerNeonatal