Nicole Michelle Brenes

Primary specialty

Gerontology Nurse PractitionerTaxonomy code 363LG0600X

License

1075837 Issued in TX

Practice address

11327 Rossie Moor LN
Richmond, TX 77407-1750

Phone

(510) 909-3521

NPI assigned

Aug 19, 2024

Last updated

Oct 25, 2024By the provider in NPPES

Sex

Female

Sole proprietor

Yes

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

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Eligible to order & refer

• Part B services: No
• Medical equipment: Yes
• Home health: No
• Power mobility devices: Yes
• Hospice: No

Green means eligible to order or refer.

Medicare enrollment (NPD)

Enrolled

Credentials

Nurse Practitioner

State licenses

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

{
    "created_epoch": "1724025600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1729814400000",
    "number": "1578395216",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "11327 ROSSIE MOOR LN",
            "city": "RICHMOND",
            "state": "TX",
            "postal_code": "774071750",
            "telephone_number": "510-909-3521"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "11327 ROSSIE MOOR LN",
            "city": "RICHMOND",
            "state": "TX",
            "postal_code": "774071750",
            "telephone_number": "510-909-3521"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BRENES",
        "first_name": "NICOLE",
        "middle_name": "MICHELLE",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2024-08-19",
        "last_updated": "2024-10-25",
        "certification_date": "2024-10-25",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LA2100X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Acute Care",
            "state": "TX",
            "license": "1075837",
            "primary": false
        },
        {
            "code": "363LG0600X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Gerontology",
            "state": "TX",
            "license": "1075837",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Melissa Bravo, SLPA
• Brazos Valley Home Health, LLC
• Christina Breadon, OTRL
• Breakthrough Healing & Wellness LLC
• Scott W Breeze, MD
• Tara Brennan, P.T., D.P.T.
• Brian Trinh, Inc (Katy Smiles Center)
• Bridge Manor Living
• Bridgeview Health Services Inc
• Bridok Healthcare and Medical Services

• Gerontology Nurse Practitioner in Richmond, TX
• Providers in Richmond, TX by specialty
• Gerontology Nurse Practitioner in Texas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 25, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.