Provider Demographics
NPI:1205667128
Name:PAINE, BRENDA SUE (RN)
Entity type:Individual
Prefix:
First Name:BRENDA
Middle Name:SUE
Last Name:PAINE
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 1:13 PITTWICK LN
Mailing Address - Street 2:
Mailing Address - City:PALM COAST
Mailing Address - State:FL
Mailing Address - Zip Code:32164-7003
Mailing Address - Country:US
Mailing Address - Phone:386-793-5452
Mailing Address - Fax:
Practice Address - Street 1:13 PITTWICK LN
Practice Address - Street 2:
Practice Address - City:PALM COAST
Practice Address - State:FL
Practice Address - Zip Code:32164-7003
Practice Address - Country:US
Practice Address - Phone:386-793-5452
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-08-12
Last Update Date:2024-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLRN9337941163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse