Basic Information
| Provider Information | |||||||||
| NPI: | 1396702676 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | RIZZO | ||||||||
| FirstName: | BRANDY | ||||||||
| MiddleName: | MARTIN | ||||||||
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| Credential: | APRN | ||||||||
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| Mailing Information | |||||||||
| Address1: | 900 WEST AVE | ||||||||
| Address2: | |||||||||
| City: | AUSTIN | ||||||||
| State: | TX | ||||||||
| PostalCode: | 787012210 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5129471897 | ||||||||
| FaxNumber: | 5124875376 | ||||||||
| Practice Location | |||||||||
| Address1: | 900 WEST AVE | ||||||||
| Address2: | |||||||||
| City: | AUSTIN | ||||||||
| State: | TX | ||||||||
| PostalCode: | 787012210 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5129471897 | ||||||||
| FaxNumber: | 5124875376 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/28/2006 | ||||||||
| LastUpdateDate: | 05/19/2010 | ||||||||
| NPIDeactivationReasonCode: | |||||||||
| NPIDeactivationDate: | 07/17/2007 | ||||||||
| NPIReactivationDate: | 11/20/2007 | ||||||||
| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363L00000X | 620516 | TX | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | 363LF0000X | 620516 | TX | N | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Family |
No ID Information.