Provider Demographics
NPI:1790532604
Name:BRENNER, AMANDA RAE (FNP)
Entity type:Individual
Prefix:
First Name:AMANDA
Middle Name:RAE
Last Name:BRENNER
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:55 ARCH ST STE 3A
Mailing Address - Street 2:
Mailing Address - City:AKRON
Mailing Address - State:OH
Mailing Address - Zip Code:44304-1447
Mailing Address - Country:US
Mailing Address - Phone:330-375-3584
Mailing Address - Fax:
Practice Address - Street 1:55 ARCH ST # A
Practice Address - Street 2:
Practice Address - City:AKRON
Practice Address - State:OH
Practice Address - Zip Code:44304-1423
Practice Address - Country:US
Practice Address - Phone:330-375-3584
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-04-30
Last Update Date:2024-05-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHAPRN.CNP.0036342363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily