Provider Demographics
NPI:1598780173
Name:BRENZA, PATRICIA J (NP)
Entity Type:Individual
Prefix:
First Name:PATRICIA
Middle Name:J
Last Name:BRENZA
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6565 FANNIN
Mailing Address - Street 2:SUITE B452
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77030-2703
Mailing Address - Country:US
Mailing Address - Phone:713-441-2677
Mailing Address - Fax:713-790-6313
Practice Address - Street 1:6565 FANNIN ST
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77030-2703
Practice Address - Country:US
Practice Address - Phone:713-790-3530
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-07-13
Last Update Date:2016-08-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX551056363LA2100X, 363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX185901901Medicaid
TX185901904Medicaid
TX185901902Medicaid
TXP01055692OtherRR MEDICARE
TX185901903Medicaid
TX8Y0334OtherBLUE CROSS BLUE SHIELD
8J3907Medicare PIN
TX309769ZSWDMedicare PIN
TX309769YMVQMedicare PIN
TX185901901Medicaid