Provider Demographics
NPI:1699742262
Name:DURRENCE-PERKINS, BRANDI LEIGH (CRNA)
Entity type:Individual
Prefix:
First Name:BRANDI
Middle Name:LEIGH
Last Name:DURRENCE-PERKINS
Suffix:
Gender:F
Credentials:CRNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1250 S 18TH ST
Mailing Address - Street 2:
Mailing Address - City:FERNANDINA BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32034-1902
Mailing Address - Country:US
Mailing Address - Phone:904-261-9106
Mailing Address - Fax:904-277-3611
Practice Address - Street 1:1250 S 18TH ST
Practice Address - Street 2:
Practice Address - City:FERNANDINA BEACH
Practice Address - State:FL
Practice Address - Zip Code:32034-1902
Practice Address - Country:US
Practice Address - Phone:904-261-9106
Practice Address - Fax:904-277-3611
Is Sole Proprietor?:No
Enumeration Date:2006-03-02
Last Update Date:2010-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN134365367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA000971066BMedicaid
GA000971066HMedicaid
FL308366700Medicaid
FLAG617YMedicare PIN
GAP71579Medicare UPIN
GA43ZCCBV06Medicare ID - Type Unspecified
FL308366700Medicaid
GA000971066BMedicaid