Provider Demographics
NPI:1861220626
Name:BRANTLEY HEALTH AND WELLNESS LLC
Entity type:Organization
Organization Name:BRANTLEY HEALTH AND WELLNESS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PROVIDER/OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:NICHOLAS
Authorized Official - Middle Name:J
Authorized Official - Last Name:BRANTLEY
Authorized Official - Suffix:SR
Authorized Official - Credentials:ARNP
Authorized Official - Phone:727-804-8193
Mailing Address - Street 1:5524 MARS HILL LN
Mailing Address - Street 2:
Mailing Address - City:PANAMA CITY
Mailing Address - State:FL
Mailing Address - Zip Code:32404-4327
Mailing Address - Country:US
Mailing Address - Phone:850-896-2742
Mailing Address - Fax:850-387-2776
Practice Address - Street 1:489 N TYNDALL PKWY
Practice Address - Street 2:
Practice Address - City:PANAMA CITY
Practice Address - State:FL
Practice Address - Zip Code:32404-6126
Practice Address - Country:US
Practice Address - Phone:850-866-7711
Practice Address - Fax:850-387-2776
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-07-23
Last Update Date:2025-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Single Specialty
No261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care