MEDICARE: MRS. JESSICA BRAUNDMEIER APRN

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	163W00000X	Registered Nurse	041.451726	IL
2	363LP0200X	Pediatric Nurse Practitioner	APRN11029460	FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	APRN11029460	OTHER	FL	STATE LICENSE

General Provider Information

NPI Number	:	1851896245
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. JESSICA BRAUNDMEIER APRN

Provider Business Mailing Address
First Line	:	3149 BOBCAT VILLAGE CENTER RD
Second Line	:
City	:	NORTH PORT
State	:	FL
Zip	:	34288-8974
Country	:	US
Telephone Number	:	618-825-1456
Fax Number	:	888-498-4926

Provider Business Practice Location Address
First Line	:	3149 BOBCAT VILLAGE CENTER RD
Second Line	:
City	:	NORTH PORT
State	:	FL
Zip	:	34288-8974
Country	:	US
Telephone Number	:	941-266-5629
Fax Number	:	888-498-4926

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/27/2018
Last Update Date	:	10/30/2023

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