Healthcare Provider Details

I. General information

NPI: 1467919316
Provider Name (Legal Business Name): BRIAN J. BRENNER APRN CNP
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/27/2019
Last Update Date: 11/03/2023
Certification Date: 10/12/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2142 N COVE BLVD
TOLEDO OH
43606-3895
US

IV. Provider business mailing address

2142 N COVE BLVD
TOLEDO OH
43606-3895
US

V. Phone/Fax

Practice location:
  • Phone: 419-291-1743
  • Fax:
Mailing address:
  • Phone: 419-291-1743
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LC0200X
TaxonomyCritical Care Medicine Nurse Practitioner
License NumberAPRN.CNP.0029949
License Number StateOH
# 2
Primary TaxonomyN
Taxonomy Code163WC0200X
TaxonomyCritical Care Medicine Registered Nurse
License NumberRN413991
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: