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General NPI Number Information
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NPI Number | 1720296049
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Entity Type | Individual
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Provider Name | BRENDA DYAL PHD, DNP APRN FNP-BC
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Gender | Female
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Dates
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Enumeration Date | 05/18/2007
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Last Update Date | 11/14/2022
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Provider Practice Location Address
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Address Line | 16939 SW 134TH AVE
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City | ARCHER
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State | FL
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Zip | 32618-5413
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Country | US
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Telephone | 352-265-2550
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Fax |
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Provider Business Mailing Address
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Address Line | 10069 SR 51 S
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City | LIVE OAK
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State | FL
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Zip | 32060-5725
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | ARNP 2967892
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License Number State | FL
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