Provider Demographics
NPI:1548463599
Name:BRANDON PREMIER HEALTHCARE PA
Entity type:Organization
Organization Name:BRANDON PREMIER HEALTHCARE PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MRS
Authorized Official - First Name:HILLARY
Authorized Official - Middle Name:LISSORN
Authorized Official - Last Name:MORGAN
Authorized Official - Suffix:
Authorized Official - Credentials:ARNP
Authorized Official - Phone:813-689-8020
Mailing Address - Street 1:907 N PARSONS AVE
Mailing Address - Street 2:
Mailing Address - City:BRANDON
Mailing Address - State:FL
Mailing Address - Zip Code:33510-3107
Mailing Address - Country:US
Mailing Address - Phone:813-689-8020
Mailing Address - Fax:813-689-8381
Practice Address - Street 1:907 N PARSONS AVE
Practice Address - Street 2:
Practice Address - City:BRANDON
Practice Address - State:FL
Practice Address - Zip Code:33510-3107
Practice Address - Country:US
Practice Address - Phone:813-689-8020
Practice Address - Fax:813-689-8381
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-06-07
Last Update Date:2017-07-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL2750432363LF0000X
207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL274805300Medicaid
FL274805300Medicaid