Provider Demographics
NPI:1124201108
Name:HOLBROOK, BRENDA (FNP-C)
Entity type:Individual
Prefix:
First Name:BRENDA
Middle Name:
Last Name:HOLBROOK
Suffix:
Gender:F
Credentials:FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4405 ROBERTS AVE
Mailing Address - Street 2:
Mailing Address - City:ANNANDALE
Mailing Address - State:VA
Mailing Address - Zip Code:22003-3511
Mailing Address - Country:US
Mailing Address - Phone:703-914-1055
Mailing Address - Fax:
Practice Address - Street 1:4405 ROBERTS AVE
Practice Address - Street 2:
Practice Address - City:ANNANDALE
Practice Address - State:VA
Practice Address - Zip Code:22003-3511
Practice Address - Country:US
Practice Address - Phone:703-914-1055
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-12-12
Last Update Date:2009-02-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0024164565363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA016775M58Medicare PIN
VA143443ZCCUMedicare PIN