Healthcare Provider Details

I. General information

NPI: 1710537212
Provider Name (Legal Business Name): BRENDA LAGARES NP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/17/2019
Last Update Date: 05/18/2026
Certification Date: 05/18/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

89 BARTLETT ST
BROOKLYN NY
11206-4463
US

IV. Provider business mailing address

3609 BROADWAY APT 3J
NEW YORK NY
10031-3235
US

V. Phone/Fax

Practice location:
  • Phone: 718-387-8181
  • Fax:
Mailing address:
  • Phone: 646-532-7916
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number359156
License Number StateNY
# 2
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number777408
License Number StateNY
# 3
Primary TaxonomyN
Taxonomy Code363LC0200X
TaxonomyCritical Care Medicine Nurse Practitioner
License Number11045130
License Number StateFL
# 4
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number359156
License Number StateNY
# 5
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number11045130
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: