Healthcare Provider Details

I. General information

NPI: 1437970159
Provider Name (Legal Business Name): BRIANNA ELISE MYERS PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/24/2024
Last Update Date: 02/05/2026
Certification Date: 02/05/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4565 US HIGHWAY 17 STE 200
FLEMING ISLAND FL
32003-4823
US

IV. Provider business mailing address

4565 US HIGHWAY 17 STE 200
FLEMING ISLAND FL
32003-4823
US

V. Phone/Fax

Practice location:
  • Phone: 904-634-0640
  • Fax: 904-634-0203
Mailing address:
  • Phone: 904-661-2394
  • Fax: 904-621-9105

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberPA9119420
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: