Provider Demographics
NPI:1295849024
Name:GRIER, BRENDA RENA (ARNPC)
Entity Type:Individual
Prefix:MRS
First Name:BRENDA
Middle Name:RENA
Last Name:GRIER
Suffix:
Gender:F
Credentials:ARNPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:250 E 4TH AVE
Mailing Address - Street 2:
Mailing Address - City:MOUNT DORA
Mailing Address - State:FL
Mailing Address - Zip Code:32757-5536
Mailing Address - Country:US
Mailing Address - Phone:352-735-1400
Mailing Address - Fax:352-735-3300
Practice Address - Street 1:250 E 4TH AVE
Practice Address - Street 2:
Practice Address - City:MOUNT DORA
Practice Address - State:FL
Practice Address - Zip Code:32757-5536
Practice Address - Country:US
Practice Address - Phone:352-735-1400
Practice Address - Fax:352-735-3300
Is Sole Proprietor?:No
Enumeration Date:2006-08-18
Last Update Date:2010-11-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLARNP 2153232363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL305984700Medicaid
Q06399Medicare UPIN
FLY044AYMedicare PIN
FL305984700Medicaid