Provider Demographics
NPI:1013234590
Name:BREBNOR, ANGELLE (MD)
Entity type:Individual
Prefix:MISS
First Name:ANGELLE
Middle Name:
Last Name:BREBNOR
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4701 N FEDERAL HWY STE B
Mailing Address - Street 2:
Mailing Address - City:FORT LAUDERDALE
Mailing Address - State:FL
Mailing Address - Zip Code:33308-4608
Mailing Address - Country:US
Mailing Address - Phone:954-229-6000
Mailing Address - Fax:954-351-3782
Practice Address - Street 1:4701 N FEDERAL HWY STE B
Practice Address - Street 2:
Practice Address - City:FORT LAUDERDALE
Practice Address - State:FL
Practice Address - Zip Code:33308
Practice Address - Country:US
Practice Address - Phone:954-229-6000
Practice Address - Fax:954-351-3782
Is Sole Proprietor?:No
Enumeration Date:2010-04-23
Last Update Date:2021-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY2743051207V00000X
FLFB7721651207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology