Healthcare Provider Details

I. General information

NPI: 1982075578
Provider Name (Legal Business Name): BRANDON DREW ANDERS PA-C
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/08/2015
Last Update Date: 07/24/2025
Certification Date: 07/24/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2402 FRIST BLVD STE 102&103
FORT PIERCE FL
34950-4838
US

IV. Provider business mailing address

2402 FRIST BLVD STE 102&103
FORT PIERCE FL
34950-4838
US

V. Phone/Fax

Practice location:
  • Phone: 772-465-4651
  • Fax: 772-465-4606
Mailing address:
  • Phone: 772-465-4651
  • Fax: 772-465-4606

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363AS0400X
TaxonomySurgical Physician Assistant
License Number
License Number StateTN
# 2
Primary TaxonomyN
Taxonomy Code363AS0400X
TaxonomySurgical Physician Assistant
License Number2796
License Number StateSC
# 3
Primary TaxonomyY
Taxonomy Code363AS0400X
TaxonomySurgical Physician Assistant
License NumberPA9109532
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: