Provider Demographics
NPI:1538998265
Name:ANTONACCIO, BRENDA LEIGH BARROS
Entity type:Individual
Prefix:
First Name:BRENDA LEIGH
Middle Name:BARROS
Last Name:ANTONACCIO
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6050 AIRLINE RD STE 109
Mailing Address - Street 2:
Mailing Address - City:ARLINGTON
Mailing Address - State:TN
Mailing Address - Zip Code:38002-4894
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:901-867-3329
Practice Address - Street 1:6050 AIRLINE RD STE 109
Practice Address - Street 2:
Practice Address - City:ARLINGTON
Practice Address - State:TN
Practice Address - Zip Code:38002-4894
Practice Address - Country:US
Practice Address - Phone:901-867-3367
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-07-31
Last Update Date:2025-05-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN36644363LP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP2300XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPrimary Care