Provider Demographics
NPI:1578318960
Name:REDQUEST, NICOLE BRANDAO (PA)
Entity type:Individual
Prefix:
First Name:NICOLE
Middle Name:BRANDAO
Last Name:REDQUEST
Suffix:
Gender:
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11809 N DALE MABRY HWY
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33618-3505
Mailing Address - Country:US
Mailing Address - Phone:813-963-2020
Mailing Address - Fax:813-265-2842
Practice Address - Street 1:11809 N DALE MABRY HWY
Practice Address - Street 2:
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33618-3505
Practice Address - Country:US
Practice Address - Phone:813-963-2020
Practice Address - Fax:813-265-2842
Is Sole Proprietor?:No
Enumeration Date:2024-04-19
Last Update Date:2025-04-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPA9118484363A00000X
SCMPA.5236363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant