Provider Demographics
NPI:1396095709
Name:BREWSTER, GLENNA SHEMIDA (RN, FNP-BC)
Entity type:Individual
Prefix:MISS
First Name:GLENNA
Middle Name:SHEMIDA
Last Name:BREWSTER
Suffix:
Gender:F
Credentials:RN, FNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3429 PARK SQ N
Mailing Address - Street 2:APT 3
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33613-4637
Mailing Address - Country:US
Mailing Address - Phone:954-200-2304
Mailing Address - Fax:
Practice Address - Street 1:3429 PARK SQ N
Practice Address - Street 2:APT 3
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33613-4637
Practice Address - Country:US
Practice Address - Phone:954-200-2304
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-09-12
Last Update Date:2012-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL9269811163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse