Provider Demographics
NPI:1861905523
Name:IFFLAND, BRENDA S (FNP-C)
Entity type:Individual
Prefix:
First Name:BRENDA
Middle Name:S
Last Name:IFFLAND
Suffix:
Gender:F
Credentials:FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:321 WILSON ST
Mailing Address - Street 2:
Mailing Address - City:HENDERSON
Mailing Address - State:TX
Mailing Address - Zip Code:75652-5957
Mailing Address - Country:US
Mailing Address - Phone:903-392-0005
Mailing Address - Fax:903-392-7772
Practice Address - Street 1:321 WILSON ST
Practice Address - Street 2:
Practice Address - City:HENDERSON
Practice Address - State:TX
Practice Address - Zip Code:75652-5957
Practice Address - Country:US
Practice Address - Phone:903-392-0005
Practice Address - Fax:903-392-7772
Is Sole Proprietor?:No
Enumeration Date:2017-11-15
Last Update Date:2023-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXAP135282363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX3842684-01Medicaid