Provider Demographics
NPI:1235812504
Name:BRENNER, CANDACE ELIZABETH (PA)
Entity Type:Individual
Prefix:
First Name:CANDACE
Middle Name:ELIZABETH
Last Name:BRENNER
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Gender:F
Credentials:PA
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Mailing Address - Street 1:SOUTH DAYTON ACUTE CARE CONSULTANTS, INC
Mailing Address - Street 2:33 W RAHN RD
Mailing Address - City:DAYTON
Mailing Address - State:OH
Mailing Address - Zip Code:45429-2219
Mailing Address - Country:US
Mailing Address - Phone:937-433-8990
Mailing Address - Fax:937-433-8691
Practice Address - Street 1:SOUTH DAYTON ACUTE CARE CONSULTANTS, INC
Practice Address - Street 2:33 W RAHN RD
Practice Address - City:DAYTON
Practice Address - State:OH
Practice Address - Zip Code:45429-2219
Practice Address - Country:US
Practice Address - Phone:937-433-8990
Practice Address - Fax:937-433-8691
Is Sole Proprietor?:No
Enumeration Date:2023-08-11
Last Update Date:2023-08-11
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Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
OH50.008300RX363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant