Provider Demographics
NPI:1386872562
Name:BRANDENBURG, VICKI MARCELLE (ARNP)
Entity type:Individual
Prefix:
First Name:VICKI
Middle Name:MARCELLE
Last Name:BRANDENBURG
Suffix:
Gender:F
Credentials:ARNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1011 W INTERNATIONAL SPEEDWAY BLVD
Mailing Address - Street 2:
Mailing Address - City:DAYTONA BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32114-3421
Mailing Address - Country:US
Mailing Address - Phone:386-238-3830
Mailing Address - Fax:386-238-3831
Practice Address - Street 1:1011 W INTERNATIONAL SPEEDWAY BLVD
Practice Address - Street 2:
Practice Address - City:DAYTONA BEACH
Practice Address - State:FL
Practice Address - Zip Code:32114-3421
Practice Address - Country:US
Practice Address - Phone:386-238-3830
Practice Address - Fax:386-238-3831
Is Sole Proprietor?:No
Enumeration Date:2009-06-26
Last Update Date:2009-06-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLARNP3331702363LW0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LW0102XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerWomen's Health