Healthcare Provider Details

I. General information

NPI: 1821904418
Provider Name (Legal Business Name): BRANDON MURRAY
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/22/2026
Last Update Date: 08/22/2026
Certification Date: 08/21/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1000 PERIGON DR UNIT 10109
PALM COAST FL
32164-7778
US

IV. Provider business mailing address

1000 PERIGON DR UNIT 10109
PALM COAST FL
32164-7778
US

V. Phone/Fax

Practice location:
  • Phone: 386-225-8451
  • Fax:
Mailing address:
  • Phone: 386-225-8451
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License NumberIMH29140
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: