Healthcare Provider Details

I. General information

NPI: 1104750678
Provider Name (Legal Business Name): JENNIFER JULIA BREWER APRN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/10/2026
Last Update Date: 06/10/2026
Certification Date: 06/10/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

115 S TIPPECANOE DR STE 3
TIPP CITY OH
45371-1194
US

IV. Provider business mailing address

2628 FIESTA DR
TROY OH
45373-4294
US

V. Phone/Fax

Practice location:
  • Phone: 937-789-8546
  • Fax:
Mailing address:
  • Phone: 937-789-8546
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License NumberAPRN.CNP.0042386
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: