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General NPI Number Information
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NPI Number | 1033789672
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Entity Type | Individual
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Provider Name | MANDY DE BRUIN CNP
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Gender | Female
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Dates
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Enumeration Date | 06/27/2021
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Last Update Date | 02/22/2024
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Provider Practice Location Address
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Address Line | 1139 LEXINGTON AVE STE A
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City | SAVANNAH
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State | GA
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Zip | 31404-5502
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Country | US
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Telephone | 912-303-4200
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Fax | 912-790-2701
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Provider Business Mailing Address
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Address Line | 1139 LEXINGTON AVE STE A
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City | SAVANNAH
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State | GA
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Zip | 31404-5502
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Country | US
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Telephone | 912-303-4200
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Fax | 912-790-2701
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LA2200X
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Taxonomy Name | Adult Health Nurse Practitioner
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License Number | 24265
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License Number State | SC
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Taxonomy #2
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Taxonomy Code | 363LA2200X
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Taxonomy Name | Adult Health Nurse Practitioner
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License Number | APRN11013219
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License Number State | FL
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Taxonomy #3
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Taxonomy Code | 363LA2200X
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Taxonomy Name | Adult Health Nurse Practitioner
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License Number | GAA-NP000003
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License Number State | GA
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