Healthcare Provider Details

I. General information

NPI: 1891337432
Provider Name (Legal Business Name): BRANDI ALEXANDER DEFIO APRN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/15/2019
Last Update Date: 10/25/2022
Certification Date: 10/25/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1600 SW ARCHER RD
GAINESVILLE FL
32610-3003
US

IV. Provider business mailing address

PO BOX 100119
GAINESVILLE FL
32610-0119
US

V. Phone/Fax

Practice location:
  • Phone: 352-265-0044
  • Fax:
Mailing address:
  • Phone: 352-273-8825
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163WP0200X
TaxonomyPediatric Registered Nurse
License Number9361275
License Number StateFL
# 2
Primary TaxonomyY
Taxonomy Code363LP0200X
TaxonomyPediatric Nurse Practitioner
License NumberAPRN11021849
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: