Provider Demographics
NPI:1154195931
Name:HARBIN, BRANDON J
Entity type:Individual
Prefix:
First Name:BRANDON
Middle Name:J
Last Name:HARBIN
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:334 2ND AVE S APT 310
Mailing Address - Street 2:
Mailing Address - City:SAINT PETERSBURG
Mailing Address - State:FL
Mailing Address - Zip Code:33701-4695
Mailing Address - Country:US
Mailing Address - Phone:864-747-5307
Mailing Address - Fax:
Practice Address - Street 1:334 2ND AVE S APT 310
Practice Address - Street 2:
Practice Address - City:SAINT PETERSBURG
Practice Address - State:FL
Practice Address - Zip Code:33701-4695
Practice Address - Country:US
Practice Address - Phone:864-747-5307
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-11-13
Last Update Date:2023-11-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLRN9588390163WC0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WC0200XNursing Service ProvidersRegistered NurseCritical Care Medicine