MEDICARE: JACQUELAINE DOROTHY BRENNAN

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363LP0808X	Psychiatric/Mental Health Nurse Practitioner	11042016	FL
2	2084P0802X	Addiction Psychiatry Physician	275317	AZ

General Provider Information

NPI Number	:	1659003168
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JACQUELAINE DOROTHY BRENNAN

Provider Business Mailing Address
First Line	:	560 VILLAGE BLVD STE 365
Second Line	:
City	:	WEST PALM BEACH
State	:	FL
Zip	:	33409-1984
Country	:	US
Telephone Number	:	561-556-1397
Fax Number	:

Provider Business Practice Location Address
First Line	:	560 VILLAGE BLVD STE 365
Second Line	:
City	:	WEST PALM BEACH
State	:	FL
Zip	:	33409-1984
Country	:	US
Telephone Number	:	561-556-1397
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/24/2022
Last Update Date	:	02/16/2026

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