Provider Demographics
NPI:1922775816
Name:GOODMAN, BRENDA LORENE (RN)
Entity Type:Individual
Prefix:
First Name:BRENDA
Middle Name:LORENE
Last Name:GOODMAN
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:925 S SEMORAN BLVD STE 110A
Mailing Address - Street 2:
Mailing Address - City:WINTER PARK
Mailing Address - State:FL
Mailing Address - Zip Code:32792-5313
Mailing Address - Country:US
Mailing Address - Phone:888-830-1050
Mailing Address - Fax:800-521-9608
Practice Address - Street 1:5353 REYNOLDS ST
Practice Address - Street 2:SELECT SPECIALITY
Practice Address - City:SAVANNAH
Practice Address - State:GA
Practice Address - Zip Code:31405
Practice Address - Country:US
Practice Address - Phone:888-830-1050
Practice Address - Fax:800-521-9608
Is Sole Proprietor?:No
Enumeration Date:2021-08-27
Last Update Date:2021-08-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN130387163WC0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WC0200XNursing Service ProvidersRegistered NurseCritical Care Medicine