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General NPI Number Information
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NPI Number | 1124865571
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Entity Type | Organization
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Legal Business Name | MORNINGSTAR MEDICAL GROUP
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Dates
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Enumeration Date | 07/12/2024
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Last Update Date | 06/18/2025
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Provider Practice Location Address
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Address Line | 1435 COLLINGSWOOD BLVD UNIT B
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City | PORT CHARLOTTE
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State | FL
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Zip | 33948-1148
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Country | US
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Telephone | 941-280-1020
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Fax | 941-216-6935
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Provider Business Mailing Address
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Address Line | 1435 COLLINGSWOOD BLVD UNIT B
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City | PORT CHARLOTTE
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State | FL
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Zip | 33948-1148
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Country | US
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Telephone | 941-223-2695
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Fax |
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Authorized Official
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Title or Position | OWNER/CEO
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Name | BRANDY HAUSER
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Credential |
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Telephone | 941-223-2695
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363L00000X
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Taxonomy Name | Nurse Practitioner
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License Number |
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License Number State |
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