Provider Demographics
NPI:1154391753
Name:BRENNAN, TERESA MARIE (DO)
Entity type:Individual
Prefix:DR
First Name:TERESA
Middle Name:MARIE
Last Name:BRENNAN
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:100 ARRICOLA AVE
Mailing Address - Street 2:
Mailing Address - City:ST AUGUSTINE
Mailing Address - State:FL
Mailing Address - Zip Code:32080-4515
Mailing Address - Country:US
Mailing Address - Phone:904-797-5740
Mailing Address - Fax:904-797-5749
Practice Address - Street 1:2460 #5 OLD MOULTRIE AVENUE
Practice Address - Street 2:
Practice Address - City:ST. AUGUSTINE
Practice Address - State:FL
Practice Address - Zip Code:32086-4198
Practice Address - Country:US
Practice Address - Phone:904-797-5740
Practice Address - Fax:904-797-5749
Is Sole Proprietor?:No
Enumeration Date:2006-01-25
Last Update Date:2012-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDH0033909207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine