MEDICARE: MRS. BRANDI RENEE FOSSUM ACNPC-AG, RNFA, CNOR

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	163W00000X	Registered Nurse	0001219358	VA
2	163WR0006X	Registered Nurse First Assistant	0001219358	VA
3	363LA2100X	Acute Care Nurse Practitioner	0024178671	VA

General Provider Information

NPI Number	:	1265852032
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. BRANDI RENEE FOSSUM ACNPC-AG, RNFA, CNOR

Provider Business Mailing Address
First Line	:	14605 POTOMAC BRANCH DR
Second Line	:
City	:	WOODBRIDGE
State	:	VA
Zip	:	22191-3336
Country	:	US
Telephone Number	:	703-490-1112
Fax Number	:	703-878-8735

Provider Business Practice Location Address
First Line	:	14605 POTOMAC BRANCH DR
Second Line	:
City	:	WOODBRIDGE
State	:	VA
Zip	:	22191-3336
Country	:	US
Telephone Number	:	703-490-1112
Fax Number	:	703-878-8735

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/21/2014
Last Update Date	:	01/24/2020

Similar Medicare Providers

1205109154 — PHYSICAL MEDICINE ASSOCIATES LTD
Practice Location Address:

14605 POTOMAC BRANCH DR , SUITE 100
WOODBRIDGE, VA
22191-3336

Practice Phone: 703-738-4371
Practice Fax: 703-580-6596

1528273406 — ASHEESH GUPTA M.D., M.P.H.
Practice Location Address:

14605 POTOMAC BRANCH DR , SUITE 300
WOODBRIDGE, VA
22191-3336

Practice Phone: 703-490-1112
Practice Fax:

1134325632 — DR. RAYMOND MARTIN HARRELL M.D.
Practice Location Address:

14605 POTOMAC BRANCH DR , SUITE 100
WOODBRIDGE, VA
22191-3336

Practice Phone: 703-738-4371
Practice Fax: 703-642-1876

1740594308 — MARINEL JACOBS PT
Practice Location Address:

14605 POTOMAC BRANCH DR , SUITE #300
WOODBRIDGE, VA
22191-3336

Practice Phone: 703-490-1330
Practice Fax: 703-878-8735

1669881124 — MATTHEW MARTONIK
Practice Location Address:

14605 POTOMAC BRANCH DR , SUITE 300
WOODBRIDGE, VA
22191-3336

Practice Phone: 703-490-1112
Practice Fax: 703-878-8735

1063088193 — SELENA RENEE BAREFOOT
Practice Location Address:

14605 POTOMAC BRANCH DR
WOODBRIDGE, VA
22191-3336

Practice Phone: 703-490-1112
Practice Fax:

Directions to “ MRS. BRANDI RENEE FOSSUM ACNPC-AG, RNFA, CNOR” Practice Location

Language	Start Address	Practice Location

These directions are for planning purposes only. You may find that construction projects, traffic, or other events may cause road conditions to differ from the map results.

Copyright © 2007-2026 (Powered by Swiss Vault Engine), all rights reserved. HIPAA liability, trademark, document use and software licensing rules apply. All registered trademarks, used in the content, are the property of their owners. Your interactions with this site are in accordance with our Terms of Use and Privacy Policy.