Provider Demographics
NPI:1235488594
Name:BRENNER, BETH ANNE (APN)
Entity Type:Individual
Prefix:MS
First Name:BETH
Middle Name:ANNE
Last Name:BRENNER
Suffix:
Gender:F
Credentials:APN
Other - Prefix:
Other - First Name:BETH
Other - Middle Name:ANNE
Other - Last Name:THOMPSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:385 MORRIS AVE
Mailing Address - Street 2:SUITE 100
Mailing Address - City:SPRINGFIELD
Mailing Address - State:NJ
Mailing Address - Zip Code:07081-1151
Mailing Address - Country:US
Mailing Address - Phone:973-379-2111
Mailing Address - Fax:973-379-2807
Practice Address - Street 1:385 MORRIS AVE
Practice Address - Street 2:SUITE 100
Practice Address - City:SPRINGFIELD
Practice Address - State:NJ
Practice Address - Zip Code:07081-1151
Practice Address - Country:US
Practice Address - Phone:973-379-2111
Practice Address - Fax:973-379-2807
Is Sole Proprietor?:No
Enumeration Date:2012-09-02
Last Update Date:2024-02-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VT101-0136659363L00000X
NJ26NJ00393900363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner