Provider Demographics
NPI:1316394521
Name:ROLLINS, BRENDA SUZANNE (FNP)
Entity Type:Individual
Prefix:
First Name:BRENDA
Middle Name:SUZANNE
Last Name:ROLLINS
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16660 PARAMOUNT BLVD STE 107
Mailing Address - Street 2:
Mailing Address - City:PARAMOUNT
Mailing Address - State:CA
Mailing Address - Zip Code:90723-5457
Mailing Address - Country:US
Mailing Address - Phone:562-924-9618
Mailing Address - Fax:562-478-4535
Practice Address - Street 1:16660 PARAMOUNT BLVD STE 107
Practice Address - Street 2:
Practice Address - City:PARAMOUNT
Practice Address - State:CA
Practice Address - Zip Code:90723-5457
Practice Address - Country:US
Practice Address - Phone:562-924-9618
Practice Address - Fax:562-478-4535
Is Sole Proprietor?:No
Enumeration Date:2016-05-17
Last Update Date:2016-05-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA567354363LF0000X
CA95002287363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily