Healthcare Provider Details

I. General information

NPI: 1689170565
Provider Name (Legal Business Name): BRANDON KENNETH JANSSEN MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/01/2018
Last Update Date: 12/10/2024
Certification Date: 12/10/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1600 SW ARCHER ROAD DEPARTMENT OF MEDICINE HOUSESTAFF OFFICE
GAINESVILLE FL
32610
US

IV. Provider business mailing address

1600 SW ARCHER ROAD DEPARTMENT OF MEDICINE HOUSESTAFF OFFICE
GAINESVILLE FL
32610
US

V. Phone/Fax

Practice location:
  • Phone: 352-265-0239
  • Fax: 352-265-1107
Mailing address:
  • Phone: 352-265-0239
  • Fax: 352-265-1107

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RP1001X
TaxonomyPulmonary Disease Physician
License NumberME167764
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberME167764
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: