Healthcare Provider Details

I. General information

NPI: 1285103648
Provider Name (Legal Business Name): BRIANNA CHEATHAM
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/15/2018
Last Update Date: 10/28/2025
Certification Date: 10/28/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

150 N SYKES CREEK PKWY
MERRITT ISLAND FL
32953-3460
US

IV. Provider business mailing address

150 N SYKES CREEK PKWY
MERRITT ISLAND FL
32953-3460
US

V. Phone/Fax

Practice location:
  • Phone: 321-452-3811
  • Fax: 321-454-4026
Mailing address:
  • Phone: 321-452-3811
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License NumberAPRN11000378
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number9408520
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: