Provider Demographics
NPI:1619646866
Name:RENART, BRANDIE LEE (PA-C)
Entity Type:Individual
Prefix:MS
First Name:BRANDIE
Middle Name:LEE
Last Name:RENART
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:650 SE INDIAN ST STE 4
Mailing Address - Street 2:
Mailing Address - City:STUART
Mailing Address - State:FL
Mailing Address - Zip Code:34997-5565
Mailing Address - Country:US
Mailing Address - Phone:772-403-2227
Mailing Address - Fax:
Practice Address - Street 1:650 SE INDIAN ST STE 4
Practice Address - Street 2:
Practice Address - City:STUART
Practice Address - State:FL
Practice Address - Zip Code:34997-5565
Practice Address - Country:US
Practice Address - Phone:772-403-2227
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-09-10
Last Update Date:2023-10-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPA9114932363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical