Healthcare Provider Details

I. General information

NPI: 1275814469
Provider Name (Legal Business Name): BRANDY LEE THOMAS RN, CNM, MSN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/01/2011
Last Update Date: 12/05/2024
Certification Date: 12/05/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5323 4TH AVENUE CIR E
BRADENTON FL
34208-5623
US

IV. Provider business mailing address

PO BOX 818018
CLEVELAND OH
44181-8018
US

V. Phone/Fax

Practice location:
  • Phone: 941-745-5115
  • Fax: 941-750-6543
Mailing address:
  • Phone: 561-300-2410
  • Fax: 561-953-4150

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367A00000X
TaxonomyAdvanced Practice Midwife
License NumberARNP9235061
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: