Provider Demographics
NPI:1245773985
Name:ADAMS, BRENDA DELOIS (RN,MSN,CDE)
Entity Type:Individual
Prefix:
First Name:BRENDA
Middle Name:DELOIS
Last Name:ADAMS
Suffix:
Gender:F
Credentials:RN,MSN,CDE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9301 NW 33RD ST
Mailing Address - Street 2:
Mailing Address - City:DORAL
Mailing Address - State:FL
Mailing Address - Zip Code:33172-1202
Mailing Address - Country:US
Mailing Address - Phone:305-904-3130
Mailing Address - Fax:305-904-3823
Practice Address - Street 1:9301 NW 33RD ST
Practice Address - Street 2:
Practice Address - City:DORAL
Practice Address - State:FL
Practice Address - Zip Code:33172-1202
Practice Address - Country:US
Practice Address - Phone:305-904-3130
Practice Address - Fax:305-904-3823
Is Sole Proprietor?:Yes
Enumeration Date:2016-11-29
Last Update Date:2016-11-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4704126485163W00000X
FLRN 9402869163WC0400X
FLRN9402869163WD0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WC0400XNursing Service ProvidersRegistered NurseCase Management
No163W00000XNursing Service ProvidersRegistered Nurse
No163WD0400XNursing Service ProvidersRegistered NurseDiabetes Educator
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLRN 9402869OtherDEPARTMENT OF HEALTH