Provider Demographics
NPI:1225141716
Name:BOYTIM, BRENDA K (APN-C, MSN)
Entity Type:Individual
Prefix:
First Name:BRENDA
Middle Name:K
Last Name:BOYTIM
Suffix:
Gender:F
Credentials:APN-C, MSN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2 HEWLINGS DR
Mailing Address - Street 2:
Mailing Address - City:MARLTON
Mailing Address - State:NJ
Mailing Address - Zip Code:08053-5310
Mailing Address - Country:US
Mailing Address - Phone:856-596-1966
Mailing Address - Fax:856-596-1966
Practice Address - Street 1:5437 8TH STREET
Practice Address - Street 2:
Practice Address - City:FORT DIX
Practice Address - State:NJ
Practice Address - Zip Code:08640-5006
Practice Address - Country:US
Practice Address - Phone:609-562-2999
Practice Address - Fax:609-562-5426
Is Sole Proprietor?:No
Enumeration Date:2006-08-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical