Healthcare Provider Details

I. General information

NPI: 1114937026
Provider Name (Legal Business Name): BRENDA L NEWMAN CNM
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/09/2006
Last Update Date: 01/18/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1215 N PEACOCK AVE
PERRY FL
32347-2117
US

IV. Provider business mailing address

1215 N PEACOCK AVE
PERRY FL
32347-2117
US

V. Phone/Fax

Practice location:
  • Phone: 850-584-5087
  • Fax: 850-584-8653
Mailing address:
  • Phone: 850-584-5087
  • Fax: 850-584-8653

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367A00000X
TaxonomyAdvanced Practice Midwife
License NumberARNP767372
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: