Provider Demographics
NPI:1366540247
Name:BRENNAN, PATRICIA MCDEED (ARNP)
Entity type:Individual
Prefix:
First Name:PATRICIA
Middle Name:MCDEED
Last Name:BRENNAN
Suffix:
Gender:F
Credentials:ARNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 628296
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32862-8296
Mailing Address - Country:US
Mailing Address - Phone:407-741-9418
Mailing Address - Fax:904-346-0113
Practice Address - Street 1:1414 S ORANGE AVE
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32806-2134
Practice Address - Country:US
Practice Address - Phone:407-841-5111
Practice Address - Fax:904-346-0113
Is Sole Proprietor?:No
Enumeration Date:2006-09-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLARNP1459332363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLE4431ZMedicare ID - Type Unspecified
FLP11593Medicare UPIN