Provider Demographics
NPI:1073632626
Name:BRENNAN, MARCI STARR (LMT)
Entity Type:Individual
Prefix:
First Name:MARCI
Middle Name:STARR
Last Name:BRENNAN
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1325 ALABELLE LN
Mailing Address - Street 2:
Mailing Address - City:NORTH PORT
Mailing Address - State:FL
Mailing Address - Zip Code:34286-7503
Mailing Address - Country:US
Mailing Address - Phone:941-423-7743
Mailing Address - Fax:
Practice Address - Street 1:210 WOOD ST
Practice Address - Street 2:
Practice Address - City:PUNTA GORDA
Practice Address - State:FL
Practice Address - Zip Code:33950-3845
Practice Address - Country:US
Practice Address - Phone:941-833-5717
Practice Address - Fax:941-833-5715
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-28
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL0017940171W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171W00000XOther Service ProvidersContractor