Provider Demographics
NPI:1669672671
Name:BRILL, RENATA SUSAN (NURSE PRACTITIONER)
Entity Type:Individual
Prefix:MS
First Name:RENATA
Middle Name:SUSAN
Last Name:BRILL
Suffix:
Gender:F
Credentials:NURSE PRACTITIONER
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Mailing Address - Street 1:21830 CYPRESS CIR APT 27C
Mailing Address - Street 2:
Mailing Address - City:BOCA RATON
Mailing Address - State:FL
Mailing Address - Zip Code:33433-3218
Mailing Address - Country:US
Mailing Address - Phone:917-376-3950
Mailing Address - Fax:
Practice Address - Street 1:14176 BLACKBERRY DR
Practice Address - Street 2:
Practice Address - City:WELLINGTON
Practice Address - State:FL
Practice Address - Zip Code:33414
Practice Address - Country:US
Practice Address - Phone:917-376-3950
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-07-19
Last Update Date:2019-10-18
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NYF303274-1363LA2200X, 363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health