Provider Demographics
NPI:1124801667
Name:POLKA, BRIANNA DANAE (FNP)
Entity type:Individual
Prefix:
First Name:BRIANNA
Middle Name:DANAE
Last Name:POLKA
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:BRIANNA
Other - Middle Name:DANAE
Other - Last Name:POLKA-GOODMAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:480 E JEFFERSON ST
Mailing Address - Street 2:
Mailing Address - City:BUTLER
Mailing Address - State:PA
Mailing Address - Zip Code:16001-4780
Mailing Address - Country:US
Mailing Address - Phone:724-282-1530
Mailing Address - Fax:724-282-1451
Practice Address - Street 1:480 E JEFFERSON ST
Practice Address - Street 2:
Practice Address - City:BUTLER
Practice Address - State:PA
Practice Address - Zip Code:16001-4780
Practice Address - Country:US
Practice Address - Phone:724-282-1530
Practice Address - Fax:724-282-1451
Is Sole Proprietor?:No
Enumeration Date:2023-08-17
Last Update Date:2025-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASP027814363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
PASP027814OtherPA NP LICENSE