Healthcare Provider Details

I. General information

NPI: 1215031729
Provider Name (Legal Business Name): ANNETTE MAGNANT BRENNER MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/13/2006
Last Update Date: 12/18/2024
Certification Date: 12/18/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

119 OAKFIELD DR
BRANDON FL
33511-5779
US

IV. Provider business mailing address

41144 24TH TER E
MYAKKA CITY FL
34251-2206
US

V. Phone/Fax

Practice location:
  • Phone: 813-571-6331
  • Fax:
Mailing address:
  • Phone: 941-920-0767
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number344627
License Number StateLA
# 2
Primary TaxonomyY
Taxonomy Code207PP0204X
TaxonomyPediatric Emergency Medicine (Emergency Medicine) Physician
License NumberME70818
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: