Individual provider Active NPI

Teresa Marie Brennan, D.O.

  • Family Medicine Physician
  • St Augustine, FL
National Provider Identifier
1154391753
Registry record updated Feb 19, 2026
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
OS11702 Issued in FL
Practice address
2460 #5 Old Moultrie Avenue
St. Augustine, FL 32086-4198
Phone
(904) 797-5740
Fax
(904) 797-5749
NPI assigned
Jan 25, 2006
Last updated
Feb 19, 2026By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Feb 19, 2026

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine Physician 207Q00000X OS11702 FL Primary

Addresses

Primary practice location

2460 #5 Old Moultrie Avenue
St. Augustine, FL 32086-4198

Mailing address

100 Arricola Ave
St Augustine, FL 32080-4515
Phone (904) 797-5740

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in FL
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: Yes
  • Hospice: Yes
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20121107000267 FL Practitioner - Family Practice 5698926269 Reassigns benefits to 3 organizations

Care Compare profile

Medicare Care Compare
Specialty
Family Practice
Education
At Still University of Health Sciences, College of Osteo Med, Kirksville, 1982
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Island Doctors Intrastate LLCGroup PAC ID 5395161186, 74 clinicians

Practice addresses (Care Compare)

2460 Old Moultrie Rd
Suite 5
St Augustine, FL 32086-4198
Phone (904) 797-5740

Hospital & facility affiliations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Osteopathy

State licenses

LicenseStateTypeSpecialty
OS11702FLMDFamily Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Island Doctors Intrastate LLC CurrentSince Jan 22, 2021 Accepting new patients
Roy H Hinman MD PA Family Medicine CurrentSince Sep 15, 2019 Accepting new patients
Dwic of Tampa Bay, Inc Past Accepting new patients

Locations

199 S US Highway 17
Ste A
East Palatka, FL 32131
Phone (386) 312-0250

100 Arricola Ave
St Augustine, FL 32080
Phone (904) 825-4368

103 Anastasia Blvd
St Augustine, FL 32080
Phone (904) 825-4747

2460 Old Moultrie Rd
Ste 2
St Augustine, FL 32086
Phone (904) 293-0299

2460 Old Moultrie Rd
Ste 5
St Augustine, FL 32086
Phone (904) 794-7870

Organizations & group practices 4

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

Hospital & facility affiliations 6

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1138147200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1771459200000",
    "number": "1154391753",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "100 ARRICOLA AVE",
            "city": "ST AUGUSTINE",
            "state": "FL",
            "postal_code": "320804515",
            "telephone_number": "904-797-5740",
            "fax_number": "904-797-5749"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2460 #5 OLD MOULTRIE AVENUE",
            "city": "ST. AUGUSTINE",
            "state": "FL",
            "postal_code": "320864198",
            "telephone_number": "904-797-5740",
            "fax_number": "904-797-5749"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BRENNAN",
        "first_name": "TERESA",
        "middle_name": "MARIE",
        "name_prefix": "Dr.",
        "credential": "D.O.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-01-25",
        "last_updated": "2026-02-19",
        "certification_date": "2026-02-19",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "FL",
            "license": "OS11702",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in St Augustine, FL

Sources for this page

Verify at the official NPI Registry.