Provider Demographics
NPI:1366779571
Name:JENNIFER MINNICK BRENNAN, APRN, BC LLC
Entity type:Organization
Organization Name:JENNIFER MINNICK BRENNAN, APRN, BC LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:JENNIFER
Authorized Official - Middle Name:MINNICK
Authorized Official - Last Name:BRENNAN
Authorized Official - Suffix:
Authorized Official - Credentials:APRN, BC
Authorized Official - Phone:732-546-6216
Mailing Address - Street 1:211 BEECHWOOD DR
Mailing Address - Street 2:
Mailing Address - City:SHREWSBURY
Mailing Address - State:NJ
Mailing Address - Zip Code:07702-4467
Mailing Address - Country:US
Mailing Address - Phone:732-546-6216
Mailing Address - Fax:
Practice Address - Street 1:621 SHREWSBURY AVE
Practice Address - Street 2:
Practice Address - City:SHREWSBURY
Practice Address - State:NJ
Practice Address - Zip Code:07702-4153
Practice Address - Country:US
Practice Address - Phone:732-741-5544
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-11-09
Last Update Date:2013-07-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ26NC10476600363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental HealthGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ168283Medicare UPIN
NJ055021Medicare UPIN