Provider Demographics
NPI:1629957162
Name:BRENA, ALEXA NICOLE (RN)
Entity type:Individual
Prefix:
First Name:ALEXA
Middle Name:NICOLE
Last Name:BRENA
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:ALEXA
Other - Middle Name:NICOLE
Other - Last Name:KINGMAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RN
Mailing Address - Street 1:9557 E BLUE RIDGE MOUNTAIN ST
Mailing Address - Street 2:
Mailing Address - City:TUCSON
Mailing Address - State:AZ
Mailing Address - Zip Code:85748-6648
Mailing Address - Country:US
Mailing Address - Phone:520-222-3997
Mailing Address - Fax:
Practice Address - Street 1:9557 E BLUE RIDGE MOUNTAIN ST
Practice Address - Street 2:
Practice Address - City:TUCSON
Practice Address - State:AZ
Practice Address - Zip Code:85748-6648
Practice Address - Country:US
Practice Address - Phone:520-222-3997
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-08-28
Last Update Date:2025-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ276293163WE0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WE0003XNursing Service ProvidersRegistered NurseEmergency