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General NPI Number Information
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NPI Number | 1548463599
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Entity Type | Organization
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Legal Business Name | BRANDON PREMIER HEALTHCARE PA
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Dates
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Enumeration Date | 06/07/2007
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Last Update Date | 07/28/2017
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Provider Practice Location Address
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Address Line | 907 N PARSONS AVE
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City | BRANDON
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State | FL
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Zip | 33510-3107
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Country | US
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Telephone | 813-689-8020
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Fax | 813-689-8381
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Provider Business Mailing Address
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Address Line | 907 N PARSONS AVE
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City | BRANDON
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State | FL
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Zip | 33510-3107
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Country | US
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Telephone | 813-689-8020
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Fax | 813-689-8381
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Authorized Official
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Title or Position | PRESIDENT
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Name | MRS. HILLARY LISSORN MORGAN
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Credential | ARNP
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Telephone | 813-689-8020
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | 2750432
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License Number State | FL
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Taxonomy #2
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number |
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License Number State |
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