Healthcare Provider Details

I. General information

NPI: 1154195931
Provider Name (Legal Business Name): BRANDON J HARBIN
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/13/2023
Last Update Date: 11/13/2023
Certification Date: 11/11/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

334 2ND AVE S APT 310
SAINT PETERSBURG FL
33701-4695
US

IV. Provider business mailing address

334 2ND AVE S APT 310
SAINT PETERSBURG FL
33701-4695
US

V. Phone/Fax

Practice location:
  • Phone: 864-747-5307
  • Fax:
Mailing address:
  • Phone: 864-747-5307
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WC0200X
TaxonomyCritical Care Medicine Registered Nurse
License NumberRN9588390
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: