Healthcare Provider Details

I. General information

NPI: 1275861627
Provider Name (Legal Business Name): BRANDY SUE MEDHURST APRN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/23/2009
Last Update Date: 10/07/2026
Certification Date: 10/07/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

505 OAKFIELD DR
BRANDON FL
33511-5700
US

IV. Provider business mailing address

505 OAKFIELD DR
BRANDON FL
33511-5700
US

V. Phone/Fax

Practice location:
  • Phone: 813-738-6686
  • Fax: 813-813-0330
Mailing address:
  • Phone: 813-738-6686
  • Fax: 813-813-0330

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAPRN9221917
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: