Provider Demographics
NPI:1326707621
Name:BRENNAN, KIMBERLY R (APN)
Entity Type:Individual
Prefix:
First Name:KIMBERLY
Middle Name:R
Last Name:BRENNAN
Suffix:
Gender:F
Credentials:APN
Other - Prefix:
Other - First Name:KIMBERLY
Other - Middle Name:
Other - Last Name:FELSBURG
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:7313 VENTNOR AVE
Mailing Address - Street 2:
Mailing Address - City:VENTNOR CITY
Mailing Address - State:NJ
Mailing Address - Zip Code:08406-1958
Mailing Address - Country:US
Mailing Address - Phone:609-441-2199
Mailing Address - Fax:609-822-1390
Practice Address - Street 1:7313 VENTNOR AVE
Practice Address - Street 2:
Practice Address - City:VENTNOR CITY
Practice Address - State:NJ
Practice Address - Zip Code:08406-1958
Practice Address - Country:US
Practice Address - Phone:609-441-2199
Practice Address - Fax:609-822-1390
Is Sole Proprietor?:No
Enumeration Date:2021-12-14
Last Update Date:2021-12-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ26NJ01236700363LP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP2300XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPrimary Care