Provider Demographics
NPI:1558665794
Name:BRENTLEY, ANDREA N (MS, RN, FNP-BC)
Entity Type:Individual
Prefix:MRS
First Name:ANDREA
Middle Name:N
Last Name:BRENTLEY
Suffix:
Gender:F
Credentials:MS, RN, FNP-BC
Other - Prefix:MS
Other - First Name:ANDREA
Other - Middle Name:
Other - Last Name:COLEMAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RN, BSN
Mailing Address - Street 1:460 W 10TH AVE
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43210-1240
Mailing Address - Country:US
Mailing Address - Phone:614-293-8619
Mailing Address - Fax:614-293-6420
Practice Address - Street 1:460 W 10TH AVE
Practice Address - Street 2:SUITE 260
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43210-1240
Practice Address - Country:US
Practice Address - Phone:614-293-8619
Practice Address - Fax:614-293-6420
Is Sole Proprietor?:No
Enumeration Date:2011-01-03
Last Update Date:2017-02-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHCOA.12955NP363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
OHPENDINGMedicaid
OHPENDINGMedicaid