Provider Demographics
NPI:1790328300
Name:BRENNAN, JOSEPH J (RN, AGPCNP-BC)
Entity Type:Individual
Prefix:MR
First Name:JOSEPH
Middle Name:J
Last Name:BRENNAN
Suffix:
Gender:M
Credentials:RN, AGPCNP-BC
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:204 COUNTY ROAD 39
Mailing Address - Street 2:
Mailing Address - City:AFTON
Mailing Address - State:NY
Mailing Address - Zip Code:13730-2252
Mailing Address - Country:US
Mailing Address - Phone:607-208-4284
Mailing Address - Fax:607-900-3336
Practice Address - Street 1:204 COUNTY ROAD 39
Practice Address - Street 2:
Practice Address - City:AFTON
Practice Address - State:NY
Practice Address - Zip Code:13730-2252
Practice Address - Country:US
Practice Address - Phone:607-208-4284
Practice Address - Fax:607-900-3336
Is Sole Proprietor?:Yes
Enumeration Date:2019-10-26
Last Update Date:2021-10-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY309695363LA2200X, 363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health