Healthcare Provider Details

I. General information

NPI: 1073158747
Provider Name (Legal Business Name): BRENDA GARCIA APRN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/17/2019
Last Update Date: 11/17/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2200 MARSH HAWK LN UNIT 101
FLEMING ISLAND FL
32003-6338
US

IV. Provider business mailing address

2200 MARSH HAWK LN UNIT 101
FLEMING ISLAND FL
32003-6338
US

V. Phone/Fax

Practice location:
  • Phone: 786-426-7972
  • Fax:
Mailing address:
  • Phone: 786-426-7972
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number11005065
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: