Healthcare Provider Details

I. General information

NPI: 1043135650
Provider Name (Legal Business Name): BRENNA ELIZABETH BAX PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/12/2026
Last Update Date: 10/07/2026
Certification Date: 10/07/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4850 MILLENIA BLVD
ORLANDO FL
32839-6012
US

IV. Provider business mailing address

4850 MILLENIA BLVD
ORLANDO FL
32839-6012
US

V. Phone/Fax

Practice location:
  • Phone: 407-264-5150
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number2026043866
License Number StateMO
# 2
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: