Provider Demographics
NPI:1144362419
Name:WHIGHAM, BRENDA K I (CRNP)
Entity type:Individual
Prefix:
First Name:BRENDA
Middle Name:K
Last Name:WHIGHAM
Suffix:I
Gender:F
Credentials:CRNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 2699
Mailing Address - Street 2:
Mailing Address - City:PENSACOLA
Mailing Address - State:FL
Mailing Address - Zip Code:32513-2699
Mailing Address - Country:US
Mailing Address - Phone:850-475-4620
Mailing Address - Fax:850-475-4619
Practice Address - Street 1:27 MACK BAYOU LOOP
Practice Address - Street 2:SUITE 1000
Practice Address - City:SANTA ROSA BEACH
Practice Address - State:FL
Practice Address - Zip Code:32459-2613
Practice Address - Country:US
Practice Address - Phone:850-622-0873
Practice Address - Fax:850-622-1912
Is Sole Proprietor?:No
Enumeration Date:2007-02-13
Last Update Date:2013-06-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLARNP9352113363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner