Healthcare Provider Details

I. General information

NPI: 1073952909
Provider Name (Legal Business Name): MEREDITH JOHNSTON BRAZELL D.O.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: MEREDITH LYNN JOHNSTON DO

II. Dates (important events)

Enumeration Date: 06/25/2013
Last Update Date: 08/04/2026
Certification Date: 08/04/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

70 VENTURE VALLEY CT STE 220
PONTE VEDRA FL
32081-6255
US

IV. Provider business mailing address

70 VENTURE VALLEY CT STE 220
PONTE VEDRA FL
32081-6255
US

V. Phone/Fax

Practice location:
  • Phone: 904-659-9818
  • Fax:
Mailing address:
  • Phone: 904-659-9818
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberOS15757
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: