Provider Demographics
NPI:1891470654
Name:MIHALAKIS, BRENDA STARR (APRN)
Entity Type:Individual
Prefix:
First Name:BRENDA
Middle Name:STARR
Last Name:MIHALAKIS
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:178 GREENTOWN RD
Mailing Address - Street 2:
Mailing Address - City:GEORGETOWN
Mailing Address - State:SC
Mailing Address - Zip Code:29440-4624
Mailing Address - Country:US
Mailing Address - Phone:843-344-7657
Mailing Address - Fax:
Practice Address - Street 1:3555 N WILLIAMSBURG COUNTY HWY
Practice Address - Street 2:
Practice Address - City:CADES
Practice Address - State:SC
Practice Address - Zip Code:29518-3008
Practice Address - Country:US
Practice Address - Phone:843-758-9622
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-06-20
Last Update Date:2023-06-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC27010363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner