Individual provider Active NPI

Christina Brennan, M.D.

  • Dermatology Physician
  • St Augustine, FL
National Provider Identifier
1215265814
Registry record updated Oct 9, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Dermatology PhysicianTaxonomy code 207N00000X
License
ME115356 Issued in FL
Practice address
1750 Tree Blvd
Suite 1
St Augustine, FL 32084-5715
Phone
(904) 824-4005
NPI assigned
Nov 20, 2009
Last updated
Oct 9, 2023By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Oct 9, 2023

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Dermatology Physician 207N00000X ME115356 FL Primary

Addresses

Primary practice location

1750 Tree Blvd
Suite 1
St Augustine, FL 32084-5715

Mailing address

15280 NW 79TH CT Ste 200
Miami Lakes, FL 33016-5873
Phone (305) 558-3724

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
I20130619000650 FL Practitioner - Dermatology 7810136025 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Dermatology
Education
Other, 2009
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Florida ENT Associates IncGroup PAC ID 4587556923, 156 clinicians

Practice addresses (Care Compare)

1750 Tree Blvd
Suite 1
St Augustine, FL 32084-5719
Phone (904) 824-4005

Merit-based Incentive Payment System (MIPS)

Final score
75 of 100Reported as individual

Procedures performed for Medicare patients

ProcedureNumber of procedures
Melanoma (skin cancer) excision110
Removal of tissue14
Removal of skin lesions2763
Removal or shaving of skin growth22
Skin biopsy824

National Provider Directory

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

Practice roles

OrganizationSpecialtyStatusNew patients
Florida ENT Associates, Inc. CurrentSince Sep 29, 2023 Accepting new patients
N.F.L. Center for Oto-HNS Facial Plastic Surgery P.a. CurrentSince Aug 1, 2013 Accepting new patients

Locations

302 W Central Ave
Lake Wales, FL 33853
Phone (863) 421-4558

15280 NW 79th Ct
Ste 200
Miami Lakes, FL 33016

1750 Tree Blvd
Ste 1
St Augustine, FL 32084
Phone (904) 824-4005

1750 Tree Blvd
Ste 10
St Augustine, FL 32084
Phone (904) 810-5434

3 San Bartola Dr
St Augustine, FL 32086
Phone (904) 823-8823

160 E Lake Howard Dr
Winter Haven, FL 33881
Phone (863) 299-1251

Interoperability endpoints

  • Direct secure messaging: cbrennan@northfloridaent.emadirect.md

Organizations & group practices 2

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.

NPI Registry JSON

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

{
    "created_epoch": "1258675200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1696809600000",
    "number": "1215265814",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "15280 NW 79TH CT STE 200",
            "city": "MIAMI LAKES",
            "state": "FL",
            "postal_code": "330165873",
            "telephone_number": "305-558-3724",
            "fax_number": "786-907-4485"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1750 TREE BLVD",
            "address_2": "SUITE 1",
            "city": "ST AUGUSTINE",
            "state": "FL",
            "postal_code": "320845715",
            "telephone_number": "904-824-4005"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BRENNAN",
        "first_name": "CHRISTINA",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2009-11-20",
        "last_updated": "2023-10-09",
        "certification_date": "2023-10-09",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207N00000X",
            "taxonomy_group": "",
            "desc": "Dermatology",
            "state": "FL",
            "license": "ME115356",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in St Augustine, FL

Sources for this page

Verify at the official NPI Registry.