Healthcare Provider Details

I. General information

NPI: 1689621633
Provider Name (Legal Business Name): ANNE ELIZABETH BRANTMAN RN CNS NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: ANNE BRANTMAN MCCORKINDALE

II. Dates (important events)

Enumeration Date: 05/27/2006
Last Update Date: 01/12/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

328 ENCINITAS BLVD #100
ENCINITAS CA
92024-8704
US

IV. Provider business mailing address

PO BOX 609001
SAN DIEGO CA
92160-9001
US

V. Phone/Fax

Practice location:
  • Phone: 760-730-4540
  • Fax: 760-274-2094
Mailing address:
  • Phone: 619-528-4600
  • Fax: 619-528-4625

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberRN561764
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License NumberNP12343
License Number StateCA
# 3
Primary TaxonomyN
Taxonomy Code364SP0808X
TaxonomyPsychiatric/Mental Health Clinical Nurse Specialist
License NumberCNS1427
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: