Healthcare Provider Details

I. General information

NPI: 1093739617
Provider Name (Legal Business Name): BRENTWOOD FAMILY CARE CENTER, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/27/2006
Last Update Date: 06/04/2025
Certification Date: 06/04/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4880 BIG ISLAND DR UNIT 3
JACKSONVILLE FL
32246-7490
US

IV. Provider business mailing address

4880 BIG ISLAND DR UNIT 3
JACKSONVILLE FL
32246-7490
US

V. Phone/Fax

Practice location:
  • Phone: 904-750-6863
  • Fax:
Mailing address:
  • Phone: 904-750-6863
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261Q00000X
TaxonomyClinic/Center
License Number
License Number State

VIII. Authorized Official

Name: DR. NANCY A WOLFE-SIDBERRY
Title or Position: PRESIDENT
Credential: M.D.
Phone: 615-370-8080