Provider Demographics
NPI:1396702676
Name:RIZZO, BRANDY MARTIN (APRN)
Entity type:Individual
Prefix:
First Name:BRANDY
Middle Name:MARTIN
Last Name:RIZZO
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:900 WEST AVE
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78701-2210
Mailing Address - Country:US
Mailing Address - Phone:512-947-1897
Mailing Address - Fax:512-487-5376
Practice Address - Street 1:900 WEST AVE
Practice Address - Street 2:
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78701-2210
Practice Address - Country:US
Practice Address - Phone:512-947-1897
Practice Address - Fax:512-487-5376
Is Sole Proprietor?:No
Enumeration Date:2006-04-28
Last Update Date:2010-05-19
Deactivation Date:2007-07-17
Deactivation Code:
Reactivation Date:2007-11-20
Provider Licenses
StateLicense IDTaxonomies
TX620516363L00000X, 363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXA10268Medicare UPIN
TX8J0890Medicare PIN