Healthcare Provider Details

I. General information

NPI: 1770584807
Provider Name (Legal Business Name): JANISE A BREWINGTON FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/10/2005
Last Update Date: 10/01/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4705 ALT 19 STE B
PALM HARBOR FL
34683-1424
US

IV. Provider business mailing address

4705 ALT 19 STE B
PALM HARBOR FL
34683-1424
US

V. Phone/Fax

Practice location:
  • Phone: 727-787-4875
  • Fax: 727-786-9623
Mailing address:
  • Phone: 727-787-4875
  • Fax: 727-786-9623

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number031848-RN
License Number StateNC
# 2
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number200856
License Number StateNC
# 3
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number031848-RN
License Number StateNC
# 4
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAPRN1451072
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: