Provider Demographics
NPI:1760133805
Name:BEJERANO, BRENDA
Entity Type:Individual
Prefix:MRS
First Name:BRENDA
Middle Name:
Last Name:BEJERANO
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:BRENDA
Other - Middle Name:
Other - Last Name:VILLAFUERTE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:BRENDA VILLAFUERTE
Mailing Address - Street 1:8220 NW 16TH ST
Mailing Address - Street 2:
Mailing Address - City:PEMBROKE PINES
Mailing Address - State:FL
Mailing Address - Zip Code:33024-4926
Mailing Address - Country:US
Mailing Address - Phone:954-682-6411
Mailing Address - Fax:
Practice Address - Street 1:8220 NW 16TH ST
Practice Address - Street 2:
Practice Address - City:PEMBROKE PINES
Practice Address - State:FL
Practice Address - Zip Code:33024-4926
Practice Address - Country:US
Practice Address - Phone:954-682-6411
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-01-11
Last Update Date:2022-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL2021085158363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGroup - Single Specialty