Individual provider Active NPI

Brandy G Milliner, NP

  • Acute Care Nurse Practitioner
  • Norfolk, VA
National Provider Identifier
1124008115
Registry record updated Feb 26, 2019
On this page

Key facts

NPPES NPI Registry
Primary specialty
Acute Care Nurse PractitionerTaxonomy code 363LA2100X
License
0024176940 Issued in VA
Practice address
600 Gresham Dr
Norfolk, VA 23507-1904
Phone
(757) 388-6115
NPI assigned
Jan 18, 2006
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Feb 26, 2019

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Military Health Care Provider 171000000X
Acute Care Nurse Practitioner 363LA2100X 0024176940 VA Primary

Addresses

Primary practice location

600 Gresham Dr
Norfolk, VA 23507-1904

Mailing address

605 Veery St
Chesapeake, VA 23323-6134
Phone (850) 321-0721

Other practice location 1

1790 Saturn Road
New Orleans, LA 70037
Phone (504) 253-6533

Other identifiers 1

IdentifierTypeStateIssuer
0024176940OtherVALICENSED NURSE PRACTITIONER

Other names 1

  • Brandy Gean Mock Former name

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in FL
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: Yes
  • Hospice: No
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20200825002533 FL Practitioner - Nurse Practitioner 3375886716 Reassigns benefits to 2 organizations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Nurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
St Vincents Ambulatory Care Inc CurrentSince Aug 21, 2020 Accepting new patients
Morton Plant Hospital Association, Inc. CurrentSince Sep 24, 2025 Accepting new patients
St Vincents Ambulatory Care Inc CurrentSince Aug 21, 2020 Accepting new patients

Locations

300 Pinellas St
Fl 1
Clearwater, FL 33756

4205 Belfort Rd
Ste 4015
Jacksonville, FL 32216
Phone (904) 296-5691

3 Shircliff Way
Ste 625
Jacksonville, FL 32204
Phone (904) 308-6900

1658 St Vincents Way
Ste 100
Middleburg, FL 32068
Phone (904) 354-8200

Organizations & group practices 3

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1137542400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1551139200000",
    "number": "1124008115",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "605 VEERY ST",
            "city": "CHESAPEAKE",
            "state": "VA",
            "postal_code": "233236134",
            "telephone_number": "850-321-0721"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "600 GRESHAM DR",
            "city": "NORFOLK",
            "state": "VA",
            "postal_code": "235071904",
            "telephone_number": "757-388-6115"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "1790 Saturn Road",
            "address_purpose": "LOCATION",
            "city": "New Orleans",
            "state": "LA",
            "postal_code": "70037",
            "country_code": "US",
            "telephone_number": "504-253-6533",
            "fax_number": "504-253-6525",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "MILLINER",
        "first_name": "BRANDY",
        "middle_name": "G",
        "name_prefix": "Mrs.",
        "credential": "NP",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-01-18",
        "last_updated": "2019-02-26",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "171000000X",
            "taxonomy_group": "",
            "desc": "Military Health Care Provider",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "363LA2100X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Acute Care",
            "state": "VA",
            "license": "0024176940",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "LICENSED NURSE PRACTITIONER",
            "identifier": "0024176940",
            "state": "VA"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "BRANDY",
            "last_name": "MOCK",
            "middle_name": "GEAN",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

Other providers in Norfolk, VA

Sources for this page

Verify at the official NPI Registry.