Provider Demographics
NPI:1811360225
Name:COSMINSKY, BRENNA (PA)
Entity type:Individual
Prefix:
First Name:BRENNA
Middle Name:
Last Name:COSMINSKY
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1405 HILLSBORO BLVD
Mailing Address - Street 2:
Mailing Address - City:MANCHESTER
Mailing Address - State:TN
Mailing Address - Zip Code:37355-2107
Mailing Address - Country:US
Mailing Address - Phone:931-954-1020
Mailing Address - Fax:
Practice Address - Street 1:1405 HILLSBORO BLVD
Practice Address - Street 2:
Practice Address - City:MANCHESTER
Practice Address - State:TN
Practice Address - Zip Code:37355-2107
Practice Address - Country:US
Practice Address - Phone:931-954-1020
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-11-06
Last Update Date:2020-01-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN2886363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical