Provider Demographics
NPI:1588993703
Name:WILLIS, BRANDI ELIZABETH (RN, ANP)
Entity type:Individual
Prefix:MRS
First Name:BRANDI
Middle Name:ELIZABETH
Last Name:WILLIS
Suffix:
Gender:F
Credentials:RN, ANP
Other - Prefix:MS
Other - First Name:BRANDI
Other - Middle Name:ELIZABETH
Other - Last Name:HALL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1505 NORTHSIDE BLVD
Mailing Address - Street 2:STE 2800
Mailing Address - City:CUMMING
Mailing Address - State:GA
Mailing Address - Zip Code:30041-7623
Mailing Address - Country:US
Mailing Address - Phone:770-886-3842
Mailing Address - Fax:770-886-3843
Practice Address - Street 1:1505 NORTHSIDE BLVD
Practice Address - Street 2:STE 2800
Practice Address - City:CUMMING
Practice Address - State:GA
Practice Address - Zip Code:30041-7623
Practice Address - Country:US
Practice Address - Phone:770-886-3842
Practice Address - Fax:770-886-3843
Is Sole Proprietor?:No
Enumeration Date:2009-12-17
Last Update Date:2014-05-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN198776363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health