Healthcare Provider Details

I. General information

NPI: 1376470997
Provider Name (Legal Business Name): SERGIO IGNACIO BRENES APRN
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/07/2026
Last Update Date: 05/07/2026
Certification Date: 05/07/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3501 JOHNSON ST
HOLLYWOOD FL
33021-5421
US

IV. Provider business mailing address

235 NW 32ND CT
MIAMI FL
33125-4912
US

V. Phone/Fax

Practice location:
  • Phone: 954-265-3401
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAPRN11042298
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: