Provider Demographics
NPI:1497893093
Name:JONES, BRENDA KAY
Entity Type:Individual
Prefix:MRS
First Name:BRENDA
Middle Name:KAY
Last Name:JONES
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11353 SHEFFIELD RD
Mailing Address - Street 2:
Mailing Address - City:SPRING HILL
Mailing Address - State:FL
Mailing Address - Zip Code:34608-2260
Mailing Address - Country:US
Mailing Address - Phone:352-683-4966
Mailing Address - Fax:352-683-4966
Practice Address - Street 1:11353 SHEFFIELD RD
Practice Address - Street 2:
Practice Address - City:SPRING HILL
Practice Address - State:FL
Practice Address - Zip Code:34608-2260
Practice Address - Country:US
Practice Address - Phone:352-683-4966
Practice Address - Fax:352-683-4966
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-03
Last Update Date:2011-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL222Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes222Q00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersDevelopmental Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL811813200Medicaid