Healthcare Provider Details

I. General information

NPI: 1083778468
Provider Name (Legal Business Name): NICHOLAS JOHN BREMER M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/20/2006
Last Update Date: 09/29/2022
Certification Date: 09/27/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1699 S 14TH ST STE 16
FERNANDINA BEACH FL
32034-1965
US

IV. Provider business mailing address

5191 FIRST COAST TECH PKWY 3RD FLOOR
JACKSONVILLE FL
32224
US

V. Phone/Fax

Practice location:
  • Phone: 904-223-3321
  • Fax:
Mailing address:
  • Phone: 904-223-3321
  • Fax: 904-223-2169

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208VP0000X
TaxonomyPain Medicine Physician
License NumberME126043
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: