Healthcare Provider Details

I. General information

NPI: 1386404101
Provider Name (Legal Business Name): BRANDY RAE POLANCO DNP, FNP-BC, FNP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/20/2024
Last Update Date: 01/20/2026
Certification Date: 01/20/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

19148 CORKSCREW RD.
ESTERO FL
33928
US

IV. Provider business mailing address

19148 ELSTON WAY
ESTERO FL
33928-6630
US

V. Phone/Fax

Practice location:
  • Phone: 941-882-0770
  • Fax:
Mailing address:
  • Phone: 714-616-8116
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP2300X
TaxonomyPrimary Care Nurse Practitioner
License Number11031904
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number11031904
License Number StateFL
# 3
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number11031904
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: