Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363L00000X | Nurse Practitioner | APRN11010517 | FL |
NPI | 1003466830 |
---|---|
Provider Name | Mr. Brandon Neil Hillard |
First Address | Jacksonville, FL 32205 |
Second Address | Jacksonville, FL 32205 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 13/09/2019 |
Last Update Date | 03/02/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
100682400 | (05) | FL |