Provider Demographics
NPI:1194509588
Name:WHITE, BRANDON (HOMEMAKER CAREGIVER)
Entity type:Individual
Prefix:
First Name:BRANDON
Middle Name:
Last Name:WHITE
Suffix:
Gender:M
Credentials:HOMEMAKER CAREGIVER
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7300 NW 1ST ST
Mailing Address - Street 2:
Mailing Address - City:PLANTATION
Mailing Address - State:FL
Mailing Address - Zip Code:33317-2252
Mailing Address - Country:US
Mailing Address - Phone:754-551-0836
Mailing Address - Fax:
Practice Address - Street 1:7300 NW 1ST ST
Practice Address - Street 2:
Practice Address - City:PLANTATION
Practice Address - State:FL
Practice Address - Zip Code:33317-2252
Practice Address - Country:US
Practice Address - Phone:754-551-0836
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-08-24
Last Update Date:2023-08-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL239098376J00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes376J00000XNursing Service Related ProvidersHomemakerGroup - Multi-Specialty