Provider Demographics
NPI:1740443746
Name:BRENDER, TIMOTHY PETER (PPCNP-BC)
Entity type:Individual
Prefix:MR
First Name:TIMOTHY
Middle Name:PETER
Last Name:BRENDER
Suffix:
Gender:M
Credentials:PPCNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:480 CENTRAL AVE BLDG 1750
Mailing Address - Street 2:
Mailing Address - City:JBPHH
Mailing Address - State:HI
Mailing Address - Zip Code:96860-4908
Mailing Address - Country:US
Mailing Address - Phone:088-471-5171
Mailing Address - Fax:
Practice Address - Street 1:480 CENTRAL AVE BLDG 1750
Practice Address - Street 2:
Practice Address - City:JBPHH
Practice Address - State:HI
Practice Address - Zip Code:96860-4908
Practice Address - Country:US
Practice Address - Phone:808-471-5171
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-07-09
Last Update Date:2022-11-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CARN572397363LP0200X
CA18189363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA572394OtherREGISTERED NURSE LICENSE
CA18189OtherNURSE PRACTITIONER CERTIFICATE