Healthcare Provider Details

I. General information

NPI: 1003466830
Provider Name (Legal Business Name): BRANDON NEIL HILLARD APRN
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/13/2019
Last Update Date: 04/03/2023
Certification Date: 04/03/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4401 EMERSON ST STE 8
JACKSONVILLE FL
32207-4954
US

IV. Provider business mailing address

4656 TUNIS STREET
JACKSONVILLE FL
32205
US

V. Phone/Fax

Practice location:
  • Phone: 904-387-9406
  • Fax: 904-212-0381
Mailing address:
  • Phone: 904-662-4853
  • Fax: 604-212-0381

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberRN9423141
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code163WH0200X
TaxonomyHome Health Registered Nurse
License NumberRN9423141
License Number StateFL
# 3
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberAPRN11010517
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: