Active NPI
Jacquelyn Tiffany Brenner, DPT
- Physical Therapist
- Port Orange, FL
National Provider Identifier
1346511490
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Physical Therapist
- License
- 26059
- Practice address
- 4645 S Clyde Morris Blvd Ste 407
Port Orange, FL 32129-3005 - Phone
- (386) 763-1771
- Fax
- (386) 763-3375
- NPI assigned
- Jan 21, 2012
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Physical Therapist | 225100000X | 26059 | FL | Primary |
Addresses
Primary practice location
4645 S Clyde Morris Blvd Ste 407
Port Orange, FL 32129-3005
Mailing address
11808 Meadow Branch Dr Apt 1128
Orlando, FL 32825-5070
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 26059 | FL | MD | Dentist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1327104000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1327104000000",
"number": "1346511490",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "11808 MEADOW BRANCH DR APT 1128",
"city": "ORLANDO",
"state": "FL",
"postal_code": "328255070"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "4645 S CLYDE MORRIS BLVD STE 407",
"city": "PORT ORANGE",
"state": "FL",
"postal_code": "321293005",
"telephone_number": "386-763-1771",
"fax_number": "386-763-3375"
}
],
"practiceLocations": [],
"basic": {
"last_name": "BRENNER",
"first_name": "JACQUELYN",
"middle_name": "TIFFANY",
"name_prefix": "Dr.",
"credential": "DPT",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2012-01-21",
"last_updated": "2012-01-21",
"status": "A"
},
"taxonomies": [
{
"code": "225100000X",
"taxonomy_group": "",
"desc": "Physical Therapist",
"state": "FL",
"license": "26059",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Port Orange, FL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 21, 2012; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.