Healthcare Provider Details

I. General information

NPI: 1801559059
Provider Name (Legal Business Name): BRANDON THOMPSON
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/14/2021
Last Update Date: 10/14/2021
Certification Date: 10/14/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6550 SANGER RD STE 180
ORLANDO FL
32827-7445
US

IV. Provider business mailing address

6550 SANGER RD STE 180
ORLANDO FL
32827-7445
US

V. Phone/Fax

Practice location:
  • Phone: 407-313-7025
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: