Provider Demographics
NPI:1124564588
Name:RENDA, BRYN (PA-C, MCMSC)
Entity Type:Individual
Prefix:
First Name:BRYN
Middle Name:
Last Name:RENDA
Suffix:
Gender:F
Credentials:PA-C, MCMSC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:850 19TH AVE N
Mailing Address - Street 2:
Mailing Address - City:ST PETERSBURG
Mailing Address - State:FL
Mailing Address - Zip Code:33704-4244
Mailing Address - Country:US
Mailing Address - Phone:407-301-6004
Mailing Address - Fax:
Practice Address - Street 1:10220 NE POINTS DR
Practice Address - Street 2:
Practice Address - City:KIRKLAND
Practice Address - State:WA
Practice Address - Zip Code:98033-7864
Practice Address - Country:US
Practice Address - Phone:425-410-4468
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-01-10
Last Update Date:2020-03-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPA9110059363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant