Provider Demographics
NPI:1871210492
Name:NOACK, BRANDY (APRN)
Entity type:Individual
Prefix:
First Name:BRANDY
Middle Name:
Last Name:NOACK
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4607 REISSWOOD LOOP
Mailing Address - Street 2:
Mailing Address - City:PALMETTO
Mailing Address - State:FL
Mailing Address - Zip Code:34221-1315
Mailing Address - Country:US
Mailing Address - Phone:386-365-4726
Mailing Address - Fax:
Practice Address - Street 1:4607 REISSWOOD LOOP
Practice Address - Street 2:
Practice Address - City:PALMETTO
Practice Address - State:FL
Practice Address - Zip Code:34221-1315
Practice Address - Country:US
Practice Address - Phone:386-365-4726
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-10-24
Last Update Date:2022-10-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLF10221243363LF0000X
FL11022704363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily