Provider Demographics
NPI:1538802426
Name:BAZAN, BRENDA C (FNP)
Entity type:Individual
Prefix:
First Name:BRENDA
Middle Name:C
Last Name:BAZAN
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3220 BUDDY OWENS AVE STE 300
Mailing Address - Street 2:
Mailing Address - City:MCALLEN
Mailing Address - State:TX
Mailing Address - Zip Code:78504-6545
Mailing Address - Country:US
Mailing Address - Phone:956-627-5245
Mailing Address - Fax:
Practice Address - Street 1:3220 BUDDY OWENS AVE STE 300
Practice Address - Street 2:
Practice Address - City:MCALLEN
Practice Address - State:TX
Practice Address - Zip Code:78504-6545
Practice Address - Country:US
Practice Address - Phone:956-627-5245
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-04-18
Last Update Date:2022-04-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1072676363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily