Provider Demographics
NPI:1194128454
Name:RENTFRO, BRENT (PA)
Entity type:Individual
Prefix:
First Name:BRENT
Middle Name:
Last Name:RENTFRO
Suffix:
Gender:M
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:44 VETERANS AVE
Mailing Address - Street 2:
Mailing Address - City:BROOKSVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:34601-3215
Mailing Address - Country:US
Mailing Address - Phone:352-797-3500
Mailing Address - Fax:352-797-3526
Practice Address - Street 1:44 VETERANS AVE
Practice Address - Street 2:
Practice Address - City:BROOKSVILLE
Practice Address - State:FL
Practice Address - Zip Code:34601-3215
Practice Address - Country:US
Practice Address - Phone:352-797-3500
Practice Address - Fax:352-797-3526
Is Sole Proprietor?:No
Enumeration Date:2014-10-01
Last Update Date:2024-02-20
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
FLPA9108229363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical