Healthcare Provider Details

I. General information

NPI: 1033125620
Provider Name (Legal Business Name): BRANDI LAINE PHILLIPS M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/01/2006
Last Update Date: 09/09/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9095 BELCHER RD N
PINELLAS PARK FL
33782-4423
US

IV. Provider business mailing address

9095 BELCHER RD N
PINELLAS PARK FL
33782-4423
US

V. Phone/Fax

Practice location:
  • Phone: 727-548-0001
  • Fax:
Mailing address:
  • Phone: 727-548-0001
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberME88223
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: