Healthcare Provider Details

I. General information

NPI: 1093928053
Provider Name (Legal Business Name): JENNIFER MINNICK BRENNAN APRN, BC, LLC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/07/2007
Last Update Date: 04/29/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

621 SHREWSBURY AVE
SHREWSBURY NJ
07702-4153
US

IV. Provider business mailing address

211 BEECHWOOD DR
SHREWSBURY NJ
07702-4467
US

V. Phone/Fax

Practice location:
  • Phone: 732-741-5544
  • Fax:
Mailing address:
  • Phone: 732-936-1716
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code364SP0809X
TaxonomyAdult Psychiatric/Mental Health Clinical Nurse Specialist
License Number26NC10476600
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: