Provider Demographics
NPI:1629626015
Name:MENARD, BRET
Entity Type:Individual
Prefix:
First Name:BRET
Middle Name:
Last Name:MENARD
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5012 SOUTHAMPTON CIR
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33647-2020
Mailing Address - Country:US
Mailing Address - Phone:337-321-1097
Mailing Address - Fax:813-972-7157
Practice Address - Street 1:5012 SOUTHAMPTON CIR
Practice Address - Street 2:
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33647-2020
Practice Address - Country:US
Practice Address - Phone:337-321-1097
Practice Address - Fax:813-972-7157
Is Sole Proprietor?:Yes
Enumeration Date:2019-08-28
Last Update Date:2019-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747A0650XNursing Service Related ProvidersTechnicianAttendant Care Provider