Provider Demographics
NPI:1124833520
Name:POBLETE-SCAGLIONE, BRANDY NICHOLE
Entity type:Individual
Prefix:
First Name:BRANDY
Middle Name:NICHOLE
Last Name:POBLETE-SCAGLIONE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:19203 STONE HEDGE DR
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33647-3532
Mailing Address - Country:US
Mailing Address - Phone:813-785-4182
Mailing Address - Fax:
Practice Address - Street 1:19203 STONE HEDGE DR
Practice Address - Street 2:
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33647-3532
Practice Address - Country:US
Practice Address - Phone:813-785-4182
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-02-11
Last Update Date:2025-02-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL16010101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health