Provider Demographics
NPI:1447902523
Name:BRENTS, SYDNEY (PA-C)
Entity type:Individual
Prefix:
First Name:SYDNEY
Middle Name:
Last Name:BRENTS
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:300 31ST AVE N APT 115
Mailing Address - Street 2:
Mailing Address - City:NASHVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37203-2475
Mailing Address - Country:US
Mailing Address - Phone:864-208-7784
Mailing Address - Fax:
Practice Address - Street 1:1140 HIGHWAY 100
Practice Address - Street 2:
Practice Address - City:CENTERVILLE
Practice Address - State:TN
Practice Address - Zip Code:37033-1139
Practice Address - Country:US
Practice Address - Phone:931-729-5551
Practice Address - Fax:931-729-5617
Is Sole Proprietor?:Yes
Enumeration Date:2022-01-20
Last Update Date:2022-07-05
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
363A00000X
TN4928363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant