Provider Demographics
NPI:1104121920
Name:BRENNAN-PRESCOD, SIMARTA FRANCES (MD)
Entity type:Individual
Prefix:DR
First Name:SIMARTA
Middle Name:FRANCES
Last Name:BRENNAN-PRESCOD
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 1:8950 DR MARTIN LUTHER KING JR ST N STE 180
Mailing Address - Street 2:
Mailing Address - City:SAINT PETERSBURG
Mailing Address - State:FL
Mailing Address - Zip Code:33702-3001
Mailing Address - Country:US
Mailing Address - Phone:727-576-8900
Mailing Address - Fax:727-570-9045
Practice Address - Street 1:8950 DR MARTIN LUTHER KING JR ST N STE 180
Practice Address - Street 2:
Practice Address - City:ST PETERSBURG
Practice Address - State:FL
Practice Address - Zip Code:33702-3001
Practice Address - Country:US
Practice Address - Phone:727-576-8900
Practice Address - Fax:727-570-9045
Is Sole Proprietor?:Yes
Enumeration Date:2011-01-26
Last Update Date:2021-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME109482207RN0300X, 207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
No207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL013457300Medicaid