Healthcare Provider Details

I. General information

NPI: 1477049591
Provider Name (Legal Business Name): BRANDI L ROTELLO FNP-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/02/2018
Last Update Date: 07/02/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

879 USERY RD
CHIPLEY FL
32428-9303
US

IV. Provider business mailing address

12201 BLUEGRASS PKWY
LOUISVILLE KY
40299-2361
US

V. Phone/Fax

Practice location:
  • Phone: 850-638-4654
  • Fax: 850-638-0918
Mailing address:
  • Phone: 502-568-7364
  • Fax: 502-568-7136

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberARNP9282947
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: