Provider Demographics
NPI:1093979668
Name:TROGDON, BRENDA R (ARNP)
Entity Type:Individual
Prefix:
First Name:BRENDA
Middle Name:R
Last Name:TROGDON
Suffix:
Gender:F
Credentials:ARNP
Other - Prefix:
Other - First Name:BRENDA
Other - Middle Name:REGISTER
Other - Last Name:ZIPPERER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:ARNP
Mailing Address - Street 1:132 E MADISON ST
Mailing Address - Street 2:
Mailing Address - City:STARKE
Mailing Address - State:FL
Mailing Address - Zip Code:32091-4043
Mailing Address - Country:US
Mailing Address - Phone:904-964-6500
Mailing Address - Fax:904-964-9170
Practice Address - Street 1:132 E MADISON ST
Practice Address - Street 2:
Practice Address - City:STARKE
Practice Address - State:FL
Practice Address - Zip Code:32091-4043
Practice Address - Country:US
Practice Address - Phone:904-964-6500
Practice Address - Fax:904-964-9170
Is Sole Proprietor?:No
Enumeration Date:2008-07-14
Last Update Date:2013-12-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLARNP3320462363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL307883300Medicaid
FL307883300Medicaid