Provider Demographics
NPI:1518361047
Name:BRENNICK, KATHRYN (DO)
Entity Type:Individual
Prefix:
First Name:KATHRYN
Middle Name:
Last Name:BRENNICK
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:951 N WASHINGTON AVE.
Mailing Address - Street 2:HOSPTIALIST DEPT
Mailing Address - City:TITUSVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32796
Mailing Address - Country:US
Mailing Address - Phone:321-268-6355
Mailing Address - Fax:321-268-6273
Practice Address - Street 1:951 N WASHINGTON AVE
Practice Address - Street 2:HOSPITALIST DEPT.
Practice Address - City:TITUSVILLE
Practice Address - State:FL
Practice Address - Zip Code:32796
Practice Address - Country:US
Practice Address - Phone:321-268-6355
Practice Address - Fax:321-268-6273
Is Sole Proprietor?:No
Enumeration Date:2014-10-13
Last Update Date:2019-12-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MST-3269207R00000X
FLOS15379208M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208M00000XAllopathic & Osteopathic PhysiciansHospitalist
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine