Provider Demographics
NPI:1912730284
Name:HAGA, BRANDIE VALYNN (FNP-DNP)
Entity type:Individual
Prefix:
First Name:BRANDIE
Middle Name:VALYNN
Last Name:HAGA
Suffix:
Gender:F
Credentials:FNP-DNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3405 OLD ANDERSON RD UNIT 112
Mailing Address - Street 2:
Mailing Address - City:ANTIOCH
Mailing Address - State:TN
Mailing Address - Zip Code:37013-1025
Mailing Address - Country:US
Mailing Address - Phone:423-943-4802
Mailing Address - Fax:
Practice Address - Street 1:3405 OLD ANDERSON RD UNIT 112
Practice Address - Street 2:
Practice Address - City:ANTIOCH
Practice Address - State:TN
Practice Address - Zip Code:37013-1025
Practice Address - Country:US
Practice Address - Phone:423-943-4802
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-08-22
Last Update Date:2024-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN36926363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily