Provider Demographics
NPI:1689818502
Name:CARRICO, BRENDA (PERSON CARE ATTENDAN)
Entity Type:Individual
Prefix:MS
First Name:BRENDA
Middle Name:
Last Name:CARRICO
Suffix:
Gender:F
Credentials:PERSON CARE ATTENDAN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:116A N. COLLEGE STREET
Mailing Address - Street 2:
Mailing Address - City:LEESBURG
Mailing Address - State:FL
Mailing Address - Zip Code:34748-2828
Mailing Address - Country:US
Mailing Address - Phone:352-874-2248
Mailing Address - Fax:
Practice Address - Street 1:116A N. COLLEGE STREET
Practice Address - Street 2:
Practice Address - City:LEESBURG
Practice Address - State:FL
Practice Address - Zip Code:34748-2828
Practice Address - Country:US
Practice Address - Phone:352-874-2248
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-04-22
Last Update Date:2009-04-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes376K00000XNursing Service Related ProvidersNurse's Aide
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL687587400Medicaid