Provider Demographics
NPI:1073158747
Name:GARCIA, BRENDA (APRN)
Entity Type:Individual
Prefix:
First Name:BRENDA
Middle Name:
Last Name:GARCIA
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2200 MARSH HAWK LN UNIT 101
Mailing Address - Street 2:
Mailing Address - City:FLEMING ISLAND
Mailing Address - State:FL
Mailing Address - Zip Code:32003-6338
Mailing Address - Country:US
Mailing Address - Phone:786-426-7972
Mailing Address - Fax:
Practice Address - Street 1:2200 MARSH HAWK LN UNIT 101
Practice Address - Street 2:
Practice Address - City:FLEMING ISLAND
Practice Address - State:FL
Practice Address - Zip Code:32003-6338
Practice Address - Country:US
Practice Address - Phone:786-426-7972
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-11-17
Last Update Date:2019-11-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL11005065363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner