Provider Demographics
NPI:1487472775
Name:RODRIGUEZ, BRANDI DAWN (NP-BC)
Entity type:Individual
Prefix:
First Name:BRANDI
Middle Name:DAWN
Last Name:RODRIGUEZ
Suffix:
Gender:F
Credentials:NP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2319 ROBERTA HWY
Mailing Address - Street 2:
Mailing Address - City:REYNOLDS
Mailing Address - State:GA
Mailing Address - Zip Code:31076-2047
Mailing Address - Country:US
Mailing Address - Phone:478-737-4085
Mailing Address - Fax:
Practice Address - Street 1:2319 ROBERTA HWY
Practice Address - Street 2:
Practice Address - City:REYNOLDS
Practice Address - State:GA
Practice Address - Zip Code:31076-2047
Practice Address - Country:US
Practice Address - Phone:478-737-4085
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-09-26
Last Update Date:2024-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN202299363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily