Provider Demographics
NPI:1992428643
Name:TALBERT, BREANNA MARIE GARCIA (AGNP)
Entity type:Individual
Prefix:
First Name:BREANNA
Middle Name:MARIE GARCIA
Last Name:TALBERT
Suffix:
Gender:F
Credentials:AGNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:600 7TH ST SE STE 200
Mailing Address - Street 2:
Mailing Address - City:CEDAR RAPIDS
Mailing Address - State:IA
Mailing Address - Zip Code:52401-2125
Mailing Address - Country:US
Mailing Address - Phone:319-369-4542
Mailing Address - Fax:319-369-5443
Practice Address - Street 1:600 7TH ST SE STE 200
Practice Address - Street 2:
Practice Address - City:CEDAR RAPIDS
Practice Address - State:IA
Practice Address - Zip Code:52401-2125
Practice Address - Country:US
Practice Address - Phone:319-369-5442
Practice Address - Fax:319-369-5443
Is Sole Proprietor?:Yes
Enumeration Date:2022-09-19
Last Update Date:2023-08-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IAH170678363LA2200X
IAJ170678363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health