Individual
LARISSA RAE BRANDENBURG
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
DO
Contact information
Practice address
NMOTC ATTN: CREDENTIALS OFFICE, 220 HOVEY RD, PENSACOLA, FL 32508
(850) 452-9484
Mailing address
NMOTC ATTN: CREDENTIALS OFFICE, 220 HOVEY RD, PENSACOLA, FL 32508
Taxonomy
Speciality
Code
Description
License number
State
171000000X
Military Health Care Provider
0102206224
VA
208D00000X
General Practice Physician
Primary
OS18242
FL
390200000X
Student in an Organized Health Care Education/Training Program
—
—
Other
Enumeration date
04/04/2019
Last updated
07/08/2024
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