Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207PP0204X | Pediatric Emergency Physician | ME70818 | FL |
NPI | 1215031729 |
---|---|
Provider Name | Dr. Annette M Brenner |
First Address | Bradenton, FL 34209-1857 |
Second Address | Brandon, FL 33511-5779 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 13/09/2006 |
Last Update Date | 02/12/2013 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
250021300 | (05) | FL |
31268 | BC/BS OF FLORIDA (01) | FL |
G25843 | (02) | FL |