Provider Demographics
NPI:1215031729
Name:BRENNER, ANNETTE MAGNANT (MD)
Entity type:Individual
Prefix:DR
First Name:ANNETTE
Middle Name:MAGNANT
Last Name:BRENNER
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 1:41144 24TH TER E
Mailing Address - Street 2:
Mailing Address - City:MYAKKA CITY
Mailing Address - State:FL
Mailing Address - Zip Code:34251-2206
Mailing Address - Country:US
Mailing Address - Phone:941-920-0767
Mailing Address - Fax:
Practice Address - Street 1:119 OAKFIELD DR
Practice Address - Street 2:
Practice Address - City:BRANDON
Practice Address - State:FL
Practice Address - Zip Code:33511-5779
Practice Address - Country:US
Practice Address - Phone:813-571-6331
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-09-13
Last Update Date:2024-12-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA344627208000000X
FLME70818207PP0204X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207PP0204XAllopathic & Osteopathic PhysiciansEmergency MedicinePediatric Emergency Medicine
No208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL250021300Medicaid
FL31268OtherBC/BS OF FLORIDA
FL312682Medicare ID - Type Unspecified
FLG25843Medicare UPIN
FL250021300Medicaid
FL31268ZMedicare PIN
FL31268XMedicare PIN