Provider Demographics
NPI:1528365673
Name:CLARKE, BRANDI NICOLE (APRN)
Entity type:Individual
Prefix:MRS
First Name:BRANDI
Middle Name:NICOLE
Last Name:CLARKE
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 1:601 BROOKER CREEK BLVD
Mailing Address - Street 2:
Mailing Address - City:OLDSMAR
Mailing Address - State:FL
Mailing Address - Zip Code:34677-2962
Mailing Address - Country:US
Mailing Address - Phone:904-826-9323
Mailing Address - Fax:844-275-0159
Practice Address - Street 1:601 BROOKER CREEK BLVD
Practice Address - Street 2:
Practice Address - City:OLDSMAR
Practice Address - State:FL
Practice Address - Zip Code:34677-2962
Practice Address - Country:US
Practice Address - Phone:904-826-9323
Practice Address - Fax:844-275-0159
Is Sole Proprietor?:No
Enumeration Date:2011-02-24
Last Update Date:2023-08-23
Deactivation Date:2021-09-11
Deactivation Code:
Reactivation Date:2021-10-18
Provider Licenses
StateLicense IDTaxonomies
FLAPRN11015297363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily