=====================================================
General NPI Number Information
=====================================================
NPI Number | 1508696782
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | BRANDI GEORGE
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 08/03/2024
-----------------------------------------------------
Last Update Date | 08/03/2024
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 100 W GORE ST STE 602
-----------------------------------------------------
City | ORLANDO
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 32806-1051
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 407-299-7333
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 220 SANDS PARC BLVD APT 202
-----------------------------------------------------
City | DAYTONA BEACH
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 32117-0047
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 814-691-4551
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 363LF0000X
-----------------------------------------------------
Taxonomy Name | Family Nurse Practitioner
-----------------------------------------------------
License Number | APRN11025701
-----------------------------------------------------
License Number State | FL
-----------------------------------------------------