Provider Demographics
NPI:1891452736
Name:ELLIS, BRENNAN PHILLIP (CRNP)
Entity type:Individual
Prefix:
First Name:BRENNAN
Middle Name:PHILLIP
Last Name:ELLIS
Suffix:
Gender:M
Credentials:CRNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:513 BROOKWOOD BLVD STE 275
Mailing Address - Street 2:
Mailing Address - City:BIRMINGHAM
Mailing Address - State:AL
Mailing Address - Zip Code:35209-6806
Mailing Address - Country:US
Mailing Address - Phone:205-502-4700
Mailing Address - Fax:877-353-3589
Practice Address - Street 1:513 BROOKWOOD BLVD STE 275
Practice Address - Street 2:
Practice Address - City:BIRMINGHAM
Practice Address - State:AL
Practice Address - Zip Code:35209-6806
Practice Address - Country:US
Practice Address - Phone:205-502-4700
Practice Address - Fax:877-353-3589
Is Sole Proprietor?:Yes
Enumeration Date:2021-11-28
Last Update Date:2025-05-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL1-161961163W00000X, 363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Single Specialty
No163W00000XNursing Service ProvidersRegistered Nurse