Provider Demographics
NPI:1871042671
Name:GUTING, BRENETH
Entity Type:Individual
Prefix:
First Name:BRENETH
Middle Name:
Last Name:GUTING
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2718 SHENANDOAH DR S
Mailing Address - Street 2:
Mailing Address - City:ORANGE PARK
Mailing Address - State:FL
Mailing Address - Zip Code:32073-6628
Mailing Address - Country:US
Mailing Address - Phone:904-708-3338
Mailing Address - Fax:
Practice Address - Street 1:2718 SHENANDOAH DR S
Practice Address - Street 2:
Practice Address - City:ORANGE PARK
Practice Address - State:FL
Practice Address - Zip Code:32073-6628
Practice Address - Country:US
Practice Address - Phone:904-708-3338
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-09-22
Last Update Date:2016-09-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL69068753747A0650X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747A0650XNursing Service Related ProvidersTechnicianAttendant Care Provider