Provider Demographics
NPI:1639181902
Name:BRENNER, HUGH (FPNP, CRNP)
Entity Type:Individual
Prefix:MR
First Name:HUGH
Middle Name:
Last Name:BRENNER
Suffix:
Gender:M
Credentials:FPNP, CRNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:186 CAMP COUNCIL RD
Mailing Address - Street 2:
Mailing Address - City:PHOENIXVILLE
Mailing Address - State:PA
Mailing Address - Zip Code:19460-1990
Mailing Address - Country:US
Mailing Address - Phone:610-896-4466
Mailing Address - Fax:321-204-6934
Practice Address - Street 1:186 CAMP COUNCIL RD
Practice Address - Street 2:
Practice Address - City:PHOENIXVILLE
Practice Address - State:PA
Practice Address - Zip Code:19460-1990
Practice Address - Country:US
Practice Address - Phone:610-896-4466
Practice Address - Fax:321-204-6934
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-13
Last Update Date:2020-11-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PARN287482L163W00000X, 364SP0810X
NJ26NR073233100163W00000X
PASP011653363LF0000X, 363LP0808X
NJ26NC07323100364SP0810X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No163W00000XNursing Service ProvidersRegistered Nurse
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No364SP0810XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse SpecialistPsychiatric/Mental Health, Child & Family
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ8463808Medicaid
NJ8463808Medicaid
S58482Medicare UPIN