Healthcare Provider Details

I. General information

NPI: 1407456783
Provider Name (Legal Business Name): BRENNA MICHELLE CLEMENTS FNP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/27/2020
Last Update Date: 06/10/2026
Certification Date: 06/10/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

711 E CAREFREE HWY STE 104
PHOENIX AZ
85085-0103
US

IV. Provider business mailing address

2233 W CLEARVIEW TRL
ANTHEM AZ
85086-3656
US

V. Phone/Fax

Practice location:
  • Phone: 309-287-6555
  • Fax: 309-326-4612
Mailing address:
  • Phone: 309-287-6555
  • Fax: 309-326-4612

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number249237
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: