Healthcare Provider Details

I. General information

NPI: 1881035491
Provider Name (Legal Business Name): BRANDI N HARDY NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/11/2013
Last Update Date: 07/31/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8503 ARLINGTON BLVD SUITE 200
FAIRFAX VA
22031-4628
US

IV. Provider business mailing address

8503 ARLINGTON BLVD SUITE 200
FAIRFAX VA
22031-4628
US

V. Phone/Fax

Practice location:
  • Phone: 703-776-8310
  • Fax: 703-776-4018
Mailing address:
  • Phone: 703-776-8310
  • Fax: 703-776-4018

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License Number0024170991
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: