Healthcare Provider Details

I. General information

NPI: 1548463599
Provider Name (Legal Business Name): BRANDON PREMIER HEALTHCARE PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/07/2007
Last Update Date: 07/28/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

907 N PARSONS AVE
BRANDON FL
33510-3107
US

IV. Provider business mailing address

907 N PARSONS AVE
BRANDON FL
33510-3107
US

V. Phone/Fax

Practice location:
  • Phone: 813-689-8020
  • Fax: 813-689-8381
Mailing address:
  • Phone: 813-689-8020
  • Fax: 813-689-8381

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number2750432
License Number StateFL

VIII. Authorized Official

Name: MRS. HILLARY LISSORN MORGAN
Title or Position: PRESIDENT
Credential: ARNP
Phone: 813-689-8020