MEDICARE: MR. BRANDON NEIL HILLARD APRN

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	163W00000X	Registered Nurse	RN9423141	FL
2	163WH0200X	Home Health Registered Nurse	RN9423141	FL
3	363L00000X	Nurse Practitioner	APRN11010517	FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1003466830
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. BRANDON NEIL HILLARD APRN

Provider Business Mailing Address
First Line	:	4656 TUNIS STREET
Second Line	:
City	:	JACKSONVILLE
State	:	FL
Zip	:	32205
Country	:	US
Telephone Number	:	904-662-4853
Fax Number	:	604-212-0381

Provider Business Practice Location Address
First Line	:	4401 EMERSON ST STE 8
Second Line	:
City	:	JACKSONVILLE
State	:	FL
Zip	:	32207-4954
Country	:	US
Telephone Number	:	904-387-9406
Fax Number	:	904-212-0381

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/13/2019
Last Update Date	:	04/03/2023

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