Provider Demographics
NPI:1417928615
Name:BROGDON, BRENDA KAY (ARNP)
Entity Type:Individual
Prefix:
First Name:BRENDA
Middle Name:KAY
Last Name:BROGDON
Suffix:
Gender:F
Credentials:ARNP
Other - Prefix:
Other - First Name:BRENDA
Other - Middle Name:KAY
Other - Last Name:HENRY
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:301 N ALEXANDER ST FL 3
Mailing Address - Street 2:
Mailing Address - City:PLANT CITY
Mailing Address - State:FL
Mailing Address - Zip Code:33563-4303
Mailing Address - Country:US
Mailing Address - Phone:813-586-8187
Mailing Address - Fax:813-321-6998
Practice Address - Street 1:301 N ALEXANDER ST FL 3
Practice Address - Street 2:
Practice Address - City:PLANT CITY
Practice Address - State:FL
Practice Address - Zip Code:33563-4303
Practice Address - Country:US
Practice Address - Phone:813-586-8187
Practice Address - Fax:813-321-6998
Is Sole Proprietor?:No
Enumeration Date:2006-01-27
Last Update Date:2022-03-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLARNP1775942363LN0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LN0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerNeonatal
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL302405900Medicaid
F53253Medicare UPIN
FLE0532ZMedicare PIN