Healthcare Provider Details

I. General information

NPI: 1477910149
Provider Name (Legal Business Name): JM HOLDINGS OF BREVARD INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/26/2016
Last Update Date: 03/09/2026
Certification Date: 03/09/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1698 W HIBISCUS BLVD SUITE B
MELBOURNE FL
32901-2639
US

IV. Provider business mailing address

1698 W HIBISCUS BLVD STE B
MELBOURNE FL
32901-2639
US

V. Phone/Fax

Practice location:
  • Phone: 321-676-3200
  • Fax: 321-802-5101
Mailing address:
  • Phone: 321-676-3200
  • Fax: 321-802-5101

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM1300X
TaxonomyMulti-Specialty Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: MR. TYLER SEXTON
Title or Position: MEDICAL DIRECTOR
Credential: MD
Phone: 321-676-3200