Healthcare Provider Details

I. General information

NPI: 1699691972
Provider Name (Legal Business Name): BRANDIE S BRADY AGACNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/29/2026
Last Update Date: 06/29/2026
Certification Date: 06/29/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3925 E FORT LOWELL RD STE 104
TUCSON AZ
85712-1053
US

IV. Provider business mailing address

8925 E 21ST ST
TUCSON AZ
85710-6211
US

V. Phone/Fax

Practice location:
  • Phone: 520-319-6000
  • Fax:
Mailing address:
  • Phone: 520-288-9353
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LA2100X
TaxonomyAcute Care Nurse Practitioner
License Number220931
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: