Healthcare Provider Details

I. General information

NPI: 1447902523
Provider Name (Legal Business Name): SYDNEY BRENTS PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/20/2022
Last Update Date: 07/05/2022
Certification Date: 07/05/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1140 HIGHWAY 100
CENTERVILLE TN
37033-1139
US

IV. Provider business mailing address

300 31ST AVE N APT 115
NASHVILLE TN
37203-2475
US

V. Phone/Fax

Practice location:
  • Phone: 931-729-5551
  • Fax: 931-729-5617
Mailing address:
  • Phone: 864-208-7784
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number4928
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: