Healthcare Provider Details

I. General information

NPI: 1548908874
Provider Name (Legal Business Name): EVAN BRADLEE BREWER CRNP
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/25/2022
Last Update Date: 07/13/2022
Certification Date: 07/13/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3610 SPRINGHILL MEMORIAL DR N
MOBILE AL
36608-1162
US

IV. Provider business mailing address

901 STERTHAUS DR
ORMOND BEACH FL
32174-5133
US

V. Phone/Fax

Practice location:
  • Phone: 251-410-3600
  • Fax:
Mailing address:
  • Phone: 251-406-1168
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAPRN11019443
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number1-263328
License Number StateAL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: