Healthcare Provider Details

I. General information

NPI: 1235812504
Provider Name (Legal Business Name): CANDACE ELIZABETH BRENNER PA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/11/2023
Last Update Date: 05/07/2026
Certification Date: 05/07/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3333 BURNET AVE
CINCINNATI OH
45229-3026
US

IV. Provider business mailing address

SOUTH DAYTON ACUTE CARE CONSULTANTS, INC 33 W RAHN RD
DAYTON OH
45429-2219
US

V. Phone/Fax

Practice location:
  • Phone: 513-636-4200
  • Fax:
Mailing address:
  • Phone: 937-433-8990
  • Fax: 937-433-8691

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number50.008300RX
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: