Provider Demographics
NPI:1912938549
Name:BRAINARD, KAREN OLSON (MD)
Entity Type:Individual
Prefix:
First Name:KAREN
Middle Name:OLSON
Last Name:BRAINARD
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6900 TAVISTOCK LAKES BLVD STE 300
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32827-7592
Mailing Address - Country:US
Mailing Address - Phone:833-309-3737
Mailing Address - Fax:321-380-1411
Practice Address - Street 1:8614 STATE ROAD 70 E STE 200
Practice Address - Street 2:
Practice Address - City:BRADENTON
Practice Address - State:FL
Practice Address - Zip Code:34202-3710
Practice Address - Country:US
Practice Address - Phone:941-727-1243
Practice Address - Fax:941-751-9039
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-05
Last Update Date:2023-07-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH6893207Q00000X
NMMD20050625207Q00000X
FLME94066207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL91107OtherBCBS PIN
FLAB229ZMedicare PIN
FLAB229YMedicare PIN
FLK0854Medicare ID - Type UnspecifiedMEDICARE GROUP #
F17627Medicare UPIN
RE2016Medicare ID - Type Unspecified