MEDICARE: AMANDA BRENNAN

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	101YM0800X	Mental Health Counselor		FL

General Provider Information

NPI Number	:	1639033459
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	AMANDA BRENNAN

Provider Business Mailing Address
First Line	:	1609 SOUTHWIND DR
Second Line	:
City	:	BRANDON
State	:	FL
Zip	:	33510-2048
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	10823 BOYETTE RD
Second Line	:
City	:	RIVERVIEW
State	:	FL
Zip	:	33569-8012
Country	:	US
Telephone Number	:	813-530-6554
Fax Number	:

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

Provider Enumeration Date	:	12/15/2025
Last Update Date	:	12/15/2025

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Directions to “ AMANDA BRENNAN ” Practice Location

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