Healthcare Provider Details

I. General information

NPI: 1639033459
Provider Name (Legal Business Name): AMANDA BRENNAN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/15/2025
Last Update Date: 12/15/2025
Certification Date: 12/15/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10823 BOYETTE RD
RIVERVIEW FL
33569-8012
US

IV. Provider business mailing address

1609 SOUTHWIND DR
BRANDON FL
33510-2048
US

V. Phone/Fax

Practice location:
  • Phone: 813-530-6554
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: