=====================================================
General NPI Number Information
=====================================================
NPI Number | 1104798594
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | ANDREA BRICKHOUSE BRANDI FNP
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 09/23/2025
-----------------------------------------------------
Last Update Date | 12/22/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 100 MEDICAL DR
-----------------------------------------------------
City | ELIZABETH CITY
-----------------------------------------------------
State | NC
-----------------------------------------------------
Zip | 27909-3361
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 252-384-2600
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 161 DOCK LANDING LOOP
-----------------------------------------------------
City | SOUTH MILLS
-----------------------------------------------------
State | NC
-----------------------------------------------------
Zip | 27976-9613
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 252-384-2600
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207Q00000X
-----------------------------------------------------
Taxonomy Name | Family Medicine Physician
-----------------------------------------------------
License Number | 5023155
-----------------------------------------------------
License Number State | NC
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 363LF0000X
-----------------------------------------------------
Taxonomy Name | Family Nurse Practitioner
-----------------------------------------------------
License Number | 5023155
-----------------------------------------------------
License Number State | NC
-----------------------------------------------------