Provider Demographics
NPI:1114937026
Name:NEWMAN, BRENDA L (CNM)
Entity Type:Individual
Prefix:
First Name:BRENDA
Middle Name:L
Last Name:NEWMAN
Suffix:
Gender:F
Credentials:CNM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1215 N PEACOCK AVE
Mailing Address - Street 2:
Mailing Address - City:PERRY
Mailing Address - State:FL
Mailing Address - Zip Code:32347-2117
Mailing Address - Country:US
Mailing Address - Phone:850-584-5087
Mailing Address - Fax:850-584-8653
Practice Address - Street 1:1215 N PEACOCK AVE
Practice Address - Street 2:
Practice Address - City:PERRY
Practice Address - State:FL
Practice Address - Zip Code:32347-2117
Practice Address - Country:US
Practice Address - Phone:850-584-5087
Practice Address - Fax:850-584-8653
Is Sole Proprietor?:No
Enumeration Date:2006-08-09
Last Update Date:2013-01-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLARNP767372367A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367A00000XPhysician Assistants & Advanced Practice Nursing ProvidersAdvanced Practice Midwife
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL033276300Medicaid