1699742262 NPI number — BRANDI LEIGH DURRENCE-PERKINS CRNA

Table of content: BRANDI LEIGH DURRENCE-PERKINS CRNA (NPI 1699742262)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1699742262 NPI number — BRANDI LEIGH DURRENCE-PERKINS CRNA

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
DURRENCE-PERKINS
Provider First Name:
BRANDI
Provider Middle Name:
LEIGH
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
CRNA
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1699742262
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
09/23/2010
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1250 S 18TH ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
FERNANDINA BEACH
Provider Business Mailing Address State Name:
FL
Provider Business Mailing Address Postal Code:
32034-1902
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
904-261-9106
Provider Business Mailing Address Fax Number:
904-277-3611

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1250 S 18TH ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
FERNANDINA BEACH
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
32034-1902
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
904-261-9106
Provider Business Practice Location Address Fax Number:
904-277-3611
Provider Enumeration Date:
03/02/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 367500000X , with the licence number:  RN134365 , registered in the state of GA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 000971066B , issued by the state of ( GA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 000971066H , issued by the state of ( GA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 308366700 , issued by the state of ( FL ) . This identifiers is of the category "MEDICAID".
  • Identifier: 115427000 . This is a "Florida Medicaid Provider ID" identifier , issued by the state of ( FL ) . This identifiers is of the category "MEDICAID".




Copyright © 2007-2025 www.npivalidator.com