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General NPI Number Information
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NPI Number | 1346075942
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Entity Type | Organization
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Legal Business Name | CHILDREN'S HEALTHCARE OF BREVARD
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Dates
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Enumeration Date | 09/04/2024
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Last Update Date | 09/04/2024
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Provider Practice Location Address
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Address Line | 2351 W EAU GALLIE BLVD STE 4
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City | MELBOURNE
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State | FL
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Zip | 32935-3114
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Country | US
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Telephone | 321-775-0477
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Fax | 321-775-0476
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Provider Business Mailing Address
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Address Line | 2351 W EAU GALLIE BLVD STE 4
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City | MELBOURNE
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State | FL
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Zip | 32935-3114
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Country | US
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Telephone | 321-775-0477
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Fax | 321-775-0476
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Authorized Official
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Title or Position | NURSE-PRACTITIONER OWNER
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Name | MS. MARGARET WITZLEB
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Credential | ARNP
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Telephone | 321-775-0477
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208000000X
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Taxonomy Name | Pediatrics Physician
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License Number |
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License Number State |
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