Provider Demographics
NPI:1043078579
Name:BRANNAN, KATE ELEISE (CNM)
Entity type:Individual
Prefix:
First Name:KATE
Middle Name:ELEISE
Last Name:BRANNAN
Suffix:
Gender:F
Credentials:CNM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2761 BOBCAT CHASE BLVD
Mailing Address - Street 2:
Mailing Address - City:OAKLAND
Mailing Address - State:FL
Mailing Address - Zip Code:34787-3764
Mailing Address - Country:US
Mailing Address - Phone:863-205-9063
Mailing Address - Fax:
Practice Address - Street 1:2761 BOBCAT CHASE BLVD
Practice Address - Street 2:
Practice Address - City:OAKLAND
Practice Address - State:FL
Practice Address - Zip Code:34787-3764
Practice Address - Country:US
Practice Address - Phone:863-205-9063
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-03-11
Last Update Date:2024-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL11031623367A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367A00000XPhysician Assistants & Advanced Practice Nursing ProvidersAdvanced Practice Midwife