Provider Demographics
NPI:1518579663
Name:BRENORD, PIERRE RICHARD (NCMA 02-287-7266)
Entity Type:Individual
Prefix:
First Name:PIERRE
Middle Name:RICHARD
Last Name:BRENORD
Suffix:
Gender:M
Credentials:NCMA 02-287-7266
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3463 FALMOUTH CT
Mailing Address - Street 2:
Mailing Address - City:TALLAHASSEE
Mailing Address - State:FL
Mailing Address - Zip Code:32317-9016
Mailing Address - Country:US
Mailing Address - Phone:631-829-8241
Mailing Address - Fax:
Practice Address - Street 1:3463 FALMOUTH CT
Practice Address - Street 2:
Practice Address - City:TALLAHASSEE
Practice Address - State:FL
Practice Address - Zip Code:32317-9016
Practice Address - Country:US
Practice Address - Phone:631-829-8241
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-08-20
Last Update Date:2020-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ363AM0700X
363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical