MEDICARE: DR. NANCIE JEAN BRENES DOM, AP

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	171100000X	Acupuncturist	AP2026	FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	C0974	OTHER	FL	BCBS OF FLORIDA

General Provider Information

NPI Number	:	1780894014
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. NANCIE JEAN BRENES DOM, AP

Provider Business Mailing Address
First Line	:	6720 69TH ST E
Second Line	:
City	:	BRADENTON
State	:	FL
Zip	:	34203-9771
Country	:	US
Telephone Number	:	941-713-3397
Fax Number	:	941-751-2345

Provider Business Practice Location Address
First Line	:	6815 14TH ST W STE 208
Second Line	:
City	:	BRADENTON
State	:	FL
Zip	:	34207-5810
Country	:	US
Telephone Number	:	941-713-3397
Fax Number	:	941-751-2345

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

Provider Enumeration Date	:	05/23/2007
Last Update Date	:	07/08/2007

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