Provider Demographics
NPI:1780894014
Name:BRENES, NANCIE JEAN (DOM, AP)
Entity type:Individual
Prefix:DR
First Name:NANCIE
Middle Name:JEAN
Last Name:BRENES
Suffix:
Gender:F
Credentials:DOM, AP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6720 69TH ST E
Mailing Address - Street 2:
Mailing Address - City:BRADENTON
Mailing Address - State:FL
Mailing Address - Zip Code:34203-9771
Mailing Address - Country:US
Mailing Address - Phone:941-713-3397
Mailing Address - Fax:941-751-2345
Practice Address - Street 1:6815 14TH ST W STE 208
Practice Address - Street 2:
Practice Address - City:BRADENTON
Practice Address - State:FL
Practice Address - Zip Code:34207-5810
Practice Address - Country:US
Practice Address - Phone:941-713-3397
Practice Address - Fax:941-751-2345
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAP2026171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLC0974OtherBCBS OF FLORIDA