Provider Demographics
NPI:1912745373
Name:GREEN, BRANDI (APRN, FNP-C)
Entity type:Individual
Prefix:
First Name:BRANDI
Middle Name:
Last Name:GREEN
Suffix:
Gender:
Credentials:APRN, FNP-C
Other - Prefix:
Other - First Name:BRANDI
Other - Middle Name:
Other - Last Name:MCKAMEY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:2574 MANASSAS WAY
Mailing Address - Street 2:
Mailing Address - City:TALLAHASSEE
Mailing Address - State:FL
Mailing Address - Zip Code:32312-4872
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:2457 CARE DR STE D100
Practice Address - Street 2:
Practice Address - City:TALLAHASSEE
Practice Address - State:FL
Practice Address - Zip Code:32308-3500
Practice Address - Country:US
Practice Address - Phone:850-841-1166
Practice Address - Fax:850-942-5466
Is Sole Proprietor?:No
Enumeration Date:2024-07-18
Last Update Date:2025-03-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAPRN11034089363LF0000X, 363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily