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: N

Provider Other Name: MEREDITH LYNN JOHNSTON

II. Dates (important events)

Enumeration Date: 06/25/2013
Last Update Date: 04/24/2025
Certification Date: 04/24/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

70 TURIN TER
ST AUGUSTINE FL
32092-0848
US

IV. Provider business mailing address

PO BOX 100296
GAINESVILLE FL
32610-0296
US

V. Phone/Fax

Practice location:
  • Phone: 904-819-2200
  • Fax: 904-819-2201
Mailing address:
  • Phone: 352-627-9350
  • Fax: 352-273-9054

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: