Provider Demographics
NPI:1982988333
Name:SMITH, BRANDI RAE (MSN, ARNP, NNP-BC)
Entity Type:Individual
Prefix:
First Name:BRANDI
Middle Name:RAE
Last Name:SMITH
Suffix:
Gender:F
Credentials:MSN, ARNP, NNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12 DESERT WILLOW CT
Mailing Address - Street 2:
Mailing Address - City:MANVEL
Mailing Address - State:TX
Mailing Address - Zip Code:77578-1511
Mailing Address - Country:US
Mailing Address - Phone:318-210-4412
Mailing Address - Fax:
Practice Address - Street 1:1000 JOE DIMAGGIO DR
Practice Address - Street 2:
Practice Address - City:HOLLYWOOD
Practice Address - State:FL
Practice Address - Zip Code:33021-5426
Practice Address - Country:US
Practice Address - Phone:954-987-5662
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-10-04
Last Update Date:2023-05-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLARNP9267162363L00000X
TXAP122378363LN0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LN0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerNeonatal
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner