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General NPI Number Information
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NPI Number | 1104445113
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Entity Type | Individual
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Provider Name | AMANDA BRENNER MD
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Gender | Female
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Dates
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Enumeration Date | 04/09/2020
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Last Update Date | 08/21/2025
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Provider Practice Location Address
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Address Line | 2436 UNIVERSITY BLVD W
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City | JACKSONVILLE
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State | FL
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Zip | 32217-2002
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Country | US
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Telephone | 904-916-1845
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Fax |
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Provider Business Mailing Address
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Address Line | 2001 KINGSLEY AVE
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City | ORANGE PARK
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State | FL
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Zip | 32073-5148
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Country | US
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Telephone | 904-639-2000
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Fax | 904-639-2015
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 390200000X
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Taxonomy Name | Student in an Organized Health Care Education/Training Program
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 207QG0300X
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Taxonomy Name | Geriatric Medicine (Family Medicine) Physician
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License Number | ME158502
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License Number State | FL
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Taxonomy #3
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | ME158502
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License Number State | FL
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Taxonomy #4
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Taxonomy Code | 208100000X
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Taxonomy Name | Physical Medicine & Rehabilitation Physician
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License Number | ME158502
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License Number State | FL
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Taxonomy #5
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Taxonomy Code | 208M00000X
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Taxonomy Name | Hospitalist Physician
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License Number | ME158502
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License Number State | FL
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