Provider Demographics
NPI:1447520960
Name:THOMPSON, BRANDI JEAN (RD, LD/N)
Entity type:Individual
Prefix:
First Name:BRANDI
Middle Name:JEAN
Last Name:THOMPSON
Suffix:
Gender:F
Credentials:RD, LD/N
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8314 DYNASTY DR
Mailing Address - Street 2:
Mailing Address - City:BOCA RATON
Mailing Address - State:FL
Mailing Address - Zip Code:33433-6839
Mailing Address - Country:US
Mailing Address - Phone:561-843-6937
Mailing Address - Fax:
Practice Address - Street 1:95 NW 11TH ST
Practice Address - Street 2:
Practice Address - City:BOCA RATON
Practice Address - State:FL
Practice Address - Zip Code:33432-2660
Practice Address - Country:US
Practice Address - Phone:561-843-6937
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-01-02
Last Update Date:2012-01-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLND4434133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered