MEDICARE: BRENNA MICHELLE CLEMENTS FNP-C

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363LF0000X	Family Nurse Practitioner	249237	AZ

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	84-4869956	OTHER		IRS

General Provider Information

NPI Number	:	1407456783
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	BRENNA MICHELLE CLEMENTS FNP-C

Provider Business Mailing Address
First Line	:	2233 W CLEARVIEW TRL
Second Line	:
City	:	ANTHEM
State	:	AZ
Zip	:	85086-3656
Country	:	US
Telephone Number	:	309-287-6555
Fax Number	:	309-326-4612

Provider Business Practice Location Address
First Line	:	711 E CAREFREE HWY STE 104
Second Line	:
City	:	PHOENIX
State	:	AZ
Zip	:	85085-0103
Country	:	US
Telephone Number	:	309-287-6555
Fax Number	:	309-326-4612

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/27/2020
Last Update Date	:	06/10/2026

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