Provider Demographics
NPI:1437547213
Name:BRENNER, TING TING (CNP)
Entity Type:Individual
Prefix:MS
First Name:TING TING
Middle Name:
Last Name:BRENNER
Suffix:
Gender:F
Credentials:CNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:560 S MAPLE ST STE 200
Mailing Address - Street 2:
Mailing Address - City:WACONIA
Mailing Address - State:MN
Mailing Address - Zip Code:55387-1757
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:560 S MAPLE ST STE 200
Practice Address - Street 2:
Practice Address - City:WACONIA
Practice Address - State:MN
Practice Address - Zip Code:55387-1757
Practice Address - Country:US
Practice Address - Phone:650-450-3005
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-01-02
Last Update Date:2022-06-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY630765163W00000X
MNCNP2682163WP0000X, 363L00000X
NYF338940-1363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No163W00000XNursing Service ProvidersRegistered Nurse
No163WP0000XNursing Service ProvidersRegistered NursePain Management
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily