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General NPI Number Information
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NPI Number | 1093600520
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Entity Type | Individual
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Provider Name | BRANDON THOMAS SPARRER
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Gender | Male
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Dates
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Enumeration Date | 06/12/2025
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Last Update Date | 06/12/2025
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Provider Practice Location Address
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Address Line | 1881 UNIVERSITY DR
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City | VIRGINIA BEACH
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State | VA
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Zip | 23453-8083
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Country | US
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Telephone | 757-683-5253
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Fax |
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Provider Business Mailing Address
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Address Line | 505 LAKESIDE DR
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City | SUFFOLK
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State | VA
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Zip | 23435-2784
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Country | US
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Telephone | 757-416-4981
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Fax |
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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 | 390200000X
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Taxonomy Name | Student in an Organized Health Care Education/Training Program
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 163W00000X
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Taxonomy Name | Registered Nurse
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License Number | 0001296456
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License Number State | VA
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