Healthcare Provider Details

I. General information

NPI: 1659313377
Provider Name (Legal Business Name): NANCY RUTH BRAINARD ARNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/10/2006
Last Update Date: 07/23/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1601 SW ARCHER RD
GAINESVILLE FL
32608-1135
US

IV. Provider business mailing address

6323 NW 37TH TER
GAINESVILLE FL
32653-0853
US

V. Phone/Fax

Practice location:
  • Phone: 352-376-1611
  • Fax: 352-271-5266
Mailing address:
  • Phone: 352-375-3757
  • Fax: 352-384-0768

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WW0000X
TaxonomyWound Care Registered Nurse
License Number1546972
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: