Provider Demographics
NPI:1992768915
Name:MIDDLEBROOKS, BRENDA DENESE (CPNP)
Entity type:Individual
Prefix:MISS
First Name:BRENDA
Middle Name:DENESE
Last Name:MIDDLEBROOKS
Suffix:
Gender:F
Credentials:CPNP
Other - Prefix:MRS
Other - First Name:BRENDA
Other - Middle Name:DENESE
Other - Last Name:SPARROW
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:5225 GOLFCREST CIR
Mailing Address - Street 2:
Mailing Address - City:STONE MOUNTAIN
Mailing Address - State:GA
Mailing Address - Zip Code:30088-4116
Mailing Address - Country:US
Mailing Address - Phone:770-808-8619
Mailing Address - Fax:770-808-5048
Practice Address - Street 1:1405 CLIFTON RD NE
Practice Address - Street 2:
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30322-1060
Practice Address - Country:US
Practice Address - Phone:404-785-6059
Practice Address - Fax:404-785-1469
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-04-10
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN097848363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics