Provider Demographics
NPI:1619268216
Name:MONTGOMERY, BRENDA JOY (FNP)
Entity Type:Individual
Prefix:
First Name:BRENDA
Middle Name:JOY
Last Name:MONTGOMERY
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 1:751 E DAILY DR
Mailing Address - Street 2:SUITE 120
Mailing Address - City:CAMARILLO
Mailing Address - State:CA
Mailing Address - Zip Code:93010-6076
Mailing Address - Country:US
Mailing Address - Phone:805-256-7810
Mailing Address - Fax:805-256-7840
Practice Address - Street 1:751 E DAILY DR
Practice Address - Street 2:SUITE 120
Practice Address - City:CAMARILLO
Practice Address - State:CA
Practice Address - Zip Code:93010-6076
Practice Address - Country:US
Practice Address - Phone:805-256-7810
Practice Address - Fax:805-256-7840
Is Sole Proprietor?:Yes
Enumeration Date:2011-04-29
Last Update Date:2016-11-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA20712363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily