Provider Demographics
NPI:1467524660
Name:TOLKSDORF, BRENDA LEIGH (CRNA)
Entity Type:Individual
Prefix:MRS
First Name:BRENDA
Middle Name:LEIGH
Last Name:TOLKSDORF
Suffix:
Gender:F
Credentials:CRNA
Other - Prefix:MISS
Other - First Name:BRENDA
Other - Middle Name:LEIGH
Other - Last Name:HOLLAND
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:CRNA
Mailing Address - Street 1:3408 BATTEY ST
Mailing Address - Street 2:
Mailing Address - City:SAVANNAH
Mailing Address - State:GA
Mailing Address - Zip Code:31405-2229
Mailing Address - Country:US
Mailing Address - Phone:912-232-2899
Mailing Address - Fax:
Practice Address - Street 1:1499 FAIR RD
Practice Address - Street 2:
Practice Address - City:STATESBORO
Practice Address - State:GA
Practice Address - Zip Code:30458-1683
Practice Address - Country:US
Practice Address - Phone:912-486-1973
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-11-14
Last Update Date:2013-12-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN103191 CRNA367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered