Provider Demographics
NPI:1013599752
Name:BRENNAN, JESSICA LOUISE (PA-C)
Entity Type:Individual
Prefix:
First Name:JESSICA
Middle Name:LOUISE
Last Name:BRENNAN
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:264 NEW SHACKLE ISLAND RD STE 107
Mailing Address - Street 2:
Mailing Address - City:HENDERSONVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37075-2481
Mailing Address - Country:US
Mailing Address - Phone:615-824-4244
Mailing Address - Fax:615-824-5916
Practice Address - Street 1:264 NEW SHACKLE ISLAND RD STE 107
Practice Address - Street 2:
Practice Address - City:HENDERSONVILLE
Practice Address - State:TN
Practice Address - Zip Code:37075-2481
Practice Address - Country:US
Practice Address - Phone:615-824-4244
Practice Address - Fax:615-824-5916
Is Sole Proprietor?:No
Enumeration Date:2021-04-22
Last Update Date:2021-09-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program