Healthcare Provider Details

I. General information

NPI: 1841938719
Provider Name (Legal Business Name): BRANDI BROCIOUS PNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: BRANDI BROCIOUS RN, CCRN, PNP

II. Dates (important events)

Enumeration Date: 05/21/2022
Last Update Date: 07/22/2023
Certification Date: 06/27/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

601 ELMWOOD AVE
ROCHESTER NY
14642-0001
US

IV. Provider business mailing address

601 ELMWOOD AVE BOX 635
ROCHESTER NY
14642-1632
US

V. Phone/Fax

Practice location:
  • Phone: 585-274-6021
  • Fax:
Mailing address:
  • Phone: 585-274-4606
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163WN0002X
TaxonomyNeonatal Intensive Care Registered Nurse
License Number630374
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code207RC0200X
TaxonomyCritical Care Medicine (Internal Medicine) Physician
License Number383387
License Number StateNY
# 3
Primary TaxonomyN
Taxonomy Code363LN0000X
TaxonomyNeonatal Nurse Practitioner
License Number383387
License Number StateNY
# 4
Primary TaxonomyY
Taxonomy Code363LP0200X
TaxonomyPediatric Nurse Practitioner
License Number383387
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: