Healthcare Provider Details

I. General information

NPI: 1770049231
Provider Name (Legal Business Name): BRANDT JOSEPH SANDERS AGACNP
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/20/2019
Last Update Date: 03/26/2024
Certification Date: 03/26/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

441 HEYMANN BLVD
LAFAYETTE LA
70503-2611
US

IV. Provider business mailing address

2730 AMBASSADOR CAFFERY PKWY
LAFAYETTE LA
70506-5939
US

V. Phone/Fax

Practice location:
  • Phone: 337-289-8429
  • Fax: 337-289-8431
Mailing address:
  • Phone: 337-988-1585
  • Fax: 337-981-4694

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LG0600X
TaxonomyGerontology Nurse Practitioner
License NumberAP203902
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: