Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 208000000X | Pediatrician | TRN13816 | FL |
N | 2080P0207X | Pediatric Hematology-Oncologist | 8228555-1205 | UT |
NPI | 1043584428 |
---|---|
Provider Name | Brenna Eldridge |
First Address | Miami, FL 33155-3009 |
Second Address | Miami, FL 33155-3009 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 01/03/2012 |
Last Update Date | 01/03/2012 |