Provider Demographics
NPI:1306839352
Name:HOLIDAY, BRENDA L (MSN/FNP-C)
Entity Type:Individual
Prefix:MS
First Name:BRENDA
Middle Name:L
Last Name:HOLIDAY
Suffix:
Gender:F
Credentials:MSN/FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2157 N ARGONAUT ST
Mailing Address - Street 2:
Mailing Address - City:STOCKTON
Mailing Address - State:CA
Mailing Address - Zip Code:95204-6201
Mailing Address - Country:US
Mailing Address - Phone:209-943-1620
Mailing Address - Fax:
Practice Address - Street 1:1307 N COMMERCE ST
Practice Address - Street 2:
Practice Address - City:STOCKTON
Practice Address - State:CA
Practice Address - Zip Code:95202-1012
Practice Address - Country:US
Practice Address - Phone:209-464-7757
Practice Address - Fax:209-464-7761
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-08-24
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA15461363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily