Healthcare Provider Details

I. General information

NPI: 1699742262
Provider Name (Legal Business Name): BRANDI LEIGH DURRENCE-PERKINS CRNA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/02/2006
Last Update Date: 09/23/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1250 S 18TH ST
FERNANDINA BEACH FL
32034-1902
US

IV. Provider business mailing address

1250 S 18TH ST
FERNANDINA BEACH FL
32034-1902
US

V. Phone/Fax

Practice location:
  • Phone: 904-261-9106
  • Fax: 904-277-3611
Mailing address:
  • Phone: 904-261-9106
  • Fax: 904-277-3611

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License NumberRN134365
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: