Provider Demographics
NPI:1982075578
Name:ANDERS, BRANDON DREW (PA-C)
Entity type:Individual
Prefix:
First Name:BRANDON
Middle Name:DREW
Last Name:ANDERS
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2402 FRIST BLVD STE 102&103
Mailing Address - Street 2:
Mailing Address - City:FORT PIERCE
Mailing Address - State:FL
Mailing Address - Zip Code:34950-4838
Mailing Address - Country:US
Mailing Address - Phone:772-465-4651
Mailing Address - Fax:772-465-4606
Practice Address - Street 1:2402 FRIST BLVD STE 102&103
Practice Address - Street 2:
Practice Address - City:FORT PIERCE
Practice Address - State:FL
Practice Address - Zip Code:34950-4838
Practice Address - Country:US
Practice Address - Phone:772-465-4651
Practice Address - Fax:772-465-4606
Is Sole Proprietor?:No
Enumeration Date:2015-10-08
Last Update Date:2022-01-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN363AS0400X
FLPA9109532363AS0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical