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Contact Information

LARISSA R BRANDENBURG, DO
NMOTC ATTN: CREDENTIALS OFFICE
220 HOVEY RD
PENSACOLA, FL32508
 Phone: 850-452-9484
 Fax:
 Website:
 

Specialty

Taxonomy Code Specialty Code Provider Type

General Practice

208D00000X 99 Physician/Undefined Physician type[6]
 

Military Health Care Provider

171000000X
 

Student in an Organized Health Care Education/Training Program

390200000X
Indicates primary specialty

NPI Profile & details for LARISSA R BRANDENBURG · (Female)

NPI # 1932661188
Status Active
Credentials DO (Doctor of Osteopathic)
Entity Individual
Enumeration date 04/04/2019
Last updated 07/08/2024 - More than a year ago
Sole proprietor 1 No
Identifiers
  • FL License # OS18242
  • VA License # 0102206224
Hospital affiliation(s) Not Available
1 A sole proprietor/sole proprietorship is an individual, and as such, is eligible for a single NPI number. The sole proprietor must apply for the NPI number using his or her own Social Security Number (SSN), not an Employer Identification Number (EIN) even if he/she has an EIN.

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